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THE 



ECLECTIC 



PRACTICE OF MEDICINE. 



BY 

JOHN M. SCUDDEK, M. D., 

professor of the theory and practice of medicine in the eclectic medical 

institute; late professor of obstetrics and diseases of women and 

children in the same; author of "a practical treatise on 

diseases of women; " of the american eclectic 

materia medica and therapeutics, etc. 



cracisr^ATi: 

MOORE, WILSTACH, KEYS & CO., Printers, 

35 WEST FOURTH STREET. 

1864. 



Entered according to Act of Congress, in the year 1863, 

BY JOHN M. SCUDDER, M. D. 

In the Clerk's office of the District Court of the United States, for the Southern 

District of Ohio. 



PREFACE. 



For some years I have been urgently solicited by members 
of my class and others to prepare a work on the Practice of 
Medicine. The constant labor incident to a large practice, 
lectures through eight months of the year, and contributions 
and Editorial supervision of the Eclectic Medical Journal, has 
hitherto seemed to present an insuperable obstacle to so doing. 
Even now, it has only been by a sacrifice of personal comfort, 
and to some extent of other engagements, that I have been 
enabled to gratify their desires. While this may account for 
many defects as a literary work, I will not offer it as an apol- 
ogy for the matter, which I have the egotism to believe will 
prove satisfactory to the reader. To render it as practical as 
possible, and a ready work of reference to the practitioner, I 
deemed it best to avoid all unnecessary description, and in 
many cases give what I believe to be facts, without adducing 
any reasons. If I had done otherwise it would have destroyed 
its usefulness as a hand-book to. those for whom the work is 
intended. I have, also, deemed it best to group diseases, not 
according to their pathological character as is usual, but accord- 
ing to the organ or part affected, believing that in this way the 
study of diagno would be easier. In conclusion, I have confi- 
dence that the treatment laid down will in no case disappoint 
the reader, if carefully employed, as it has been the result of 
close investigation and extensive experience. 

THE AUTHOR. 



THE 



ECLECTIC PRACTICE OF MEDICINE 



CHAPTER I. 

FEBRILE DISEASES. 

Fever is divided into two classes, idiopathic and symptomatic ; 
in the first, there is no apreciable lesion of the solids, at least 
at its commencement, we therefore say that it is primarily a 
disease of the fluids of the body ; in the second there is pri- 
marily an inflammation which induces febrile reaction, the 
fever being a secondary disease. 

What change in the fluids of the body will give rise to fever ? 
I know of but one, and that is the presence of some material 
that has so far lost its vitalization that it can not be applied to 
the nutrition of the textures, or serve any purpose in the 
animal economy. Such material may be generated within the 
body, or it may be introduced from without. In order to prove 
this proposition, I will describe next, 

The Causes of Fever. — 1st. From great excitation or depres- 
sion of the mind we may have such change in innervation as 
will induce the above named condition of the blood. We well 
know that the depressing emotions, of fear, grief, etc., occa- 
sion a slow and languid circulation of the blood, with more or 
less congestion, and arrest of secretion. If there is stasis of 
blood, that fluid is impaired in proportion to its continuance 
and extent, certain portions loosing their vitality, thereby be- 
coming material foreign to its constitution ; arrest of secretion 
causes retention of the efl'ete material of the secretions. 
Emotional excitement gives rise, first, to a rapid breaking 
down of the tissues, and second, by the subsequent prostration 
and consequent failure in the excreting organs, to the retention 
of this effete material. During febrile epidemics emotional 



6 The Eclectic Practice of Medicine. 

excitement very frequently proves the exciting clause of the 
disease. 2d. Suppression of the excretions will induce the 
same condition of the blood. The materials excreted from the 
body have undergone such change before excretion that they 
can no longer subserve any purpose in the animal economy, 
and therefore if retained by failure of the excretory organs to 
remove them must prove a cause of diseas^. 3d. Causes in- 
ducing congestion. As before remarked, if there is congestion 
of blood, a retrograde metamorphosis ensues, in which certain 
portions are so devitalized that they are unfitted for the pur- 
poses of the economy, becoming in fact elements foreign to the 
blood. 4th. Morbid material introduced into the blood from 
without; as gaseous exhalations from decomposing animal or 
vegetable matter, which gains entrance into the circulation 
through the lungs; or decomposing animal matter, which may 
be absorbed from the skin, mucous membranes, etc. 

What is the Nature of this Materies Morbi ? — I would 
define it to be any substance of lower organization than the 
blood — an organized body which is undergoing retrograde meta- 
morphosis, and* which will act as a diastase in the blood, effecting 
a similar destruction in every molecule of the blood that has 
not sufficient vital power to resist this change. Liebig com- 
pares the action of such material within the blood, to diastase, 
or yeast, having the property of inducing the same state 
of decomposition in all organized bodies with which they may 
be brought in contact. 

If this is so, when such material is generated within the 
blood or introduced into it from without, there would be con- 
tinued increase in its quantity. It would effect every portion 
of the system ; nutrition could not be perfectly performed, be- 
cause the quality of the nutritive material is impaired; iner- 
vation is affected, not only from the want of a properly 
constituted nutritive material, but also from the lack of the 
normal stimulus furnished by properly elaborated blood in the 
commencement, and by. a greatly increased stimulation when 
reaction takes place, for the removal of the offending substance ; 
the secretions are vitiated, from the vitiated material in circu- 
lation, and we would thus have impaired digestion. 

A very good example of the action of a blood poison, is 
afforded us by innoculation for the small pox. The smallest 
quantity of virus, if placed where it can be readily taken 
into the blood, is as potent as a larger one. At first there is 



Febrile Diseases. 7 

no disturbance of the system, the quantity of the poison being 
too small. But it increases day by day, and in time a gradu- 
ally increasing depression, manifested by listlessness, languor, 
loss of appetite, morbid innervation, and arrest of secretion. 
Finally the depression becomes so great that there does not 
seem to be power enough in the system to circulate the blood, 
the result being a chill of variable duration. If this continues, 
vitality will be destroyed, hence in a longer or shorter time we 
find the energies of the system concentrated to overcome 
it; the result being febrile reaction, which ceases only when 
the material introduced has been entirely removed. In this 
case it is principally thrown upon the surface as a pustular 
eruption, but we notice that the poison has been wonderfully 
increased, as each pustule contains possibly a hundred or a 
thousand times the quantity introduced. This virus has been 
produced from the blood by the action of the original minute 
portion on the blood. 

As another instance, take a person who has been exerting 
himself more than usual, this exertion has caused a greatly in- 
creased disintegration of tissue, which partially disorganized 
material remains in the blood. The exertion has been attended 
with increased excretion from the kidneys and skin, the last 
being especially manifest by the free perspiration. At this time 
the person ceases his exertion, and sits down in a damp place, or 
in a draught of cold air, the effect being to stop the secretion 
from the skin, and the material that would have been thus 
removed, is retained within the circulation. Not only so, but 
the blood is driven from the surface to internal parts of the 
body, embarrassing the action of the internal excretory organs. 
Now, if vicarious excretion does not occur from the kidneys 
or intestines, the result will be fever, or inflammation of some 
structure of the body accompanied by it. What are the phe- 
nomena that follow ? There is first a torpor of all the functions 
of the system, followed by a chill or rigor, and this by febrile 
reaction, which terminates only when free secretion is estab- 
lished. 

Dr. Stevens well remarks, " that it is but a poor objection to 
say that neither the contagious poisons nor the marsh miasma 
can be detected in the blood by any chemical test. Those 
agents, like the vital principle or caloric, are invisible ; but 
like vitality, or the cause of heat, the aerial poisons produce 
the most visible effects. Whatever the origin of these agents 



8 The Eclectic Practice of Medicine. 

may be, it is now, I believe, generally admitted that poisons 
often exist in the atmosphere, acting as the remote cause of 
fever ; and if chemists do not yet possess any test to enable us 
to detect them in so simple a fluid as atmospheric air, we can 
scarcely expect to find them in one that is so complicated as 
the blood. When chemistry can detect them in the one, the 
same test may enable us to prove their existence in the other ; 
until then, we may believe they exist in the blood, not only 
from the visible effects they produce in that fluid, but from the 
same evidence that we believe in their atmospheric existence, 
that is from their effects ; for, as yet, we have nothing else to 
enable us to prove that these poisons ever exist as the remote 
cause of those fevers which we believe to be produced by the 
aerial poisons. But when the air produces in those that breathe 
it, a specific fever, with a cold stage, an irritable stomach, a 
foul tongue, derangement in the biliary organs, disordered 
secretions and the other symptoms of contagious or miasmatic 
fevers, we then believe that such air contains a poison. For 
the same reason, when the poison enters the system unper- 
ceived, and without producing any immediate effect on the 
nervous system — when it remains dormant for days in the body 
without producing any change, except in the blood — when we 
see that the whole current is dark in color, and diseased in its 
appearance, even before the attack, when this diseased blood 
first paralyzes the heart and then produces fever, with an irri- 
table stomach, a foul tongue, and the other specific symptoms 
peculiar to this class of fevers, we may then on the same evi- 
dence, believe that the poison has entered the circulation, and 
that this is the cause ; while the paralysis, the reaction, and 
the other symptoms which occur in the solids are merely the 
effects of the disordered state of the nutritive fluid." 

Phenomena op Fever. — A fever is composed of four stages ; 
1st, a stage of incubation, of variable duration ; 2d, a cold stage : 
3d, a hot stage ; and 4th, a stage of excretion, or as it is com- 
monly termed the sweating stage. These follow one another 
in the order they are named, and each one may be considered 
as the natural sequence of the one that preceeded it. 

Stage of Incubation. — The symptoms are, languor, listless- 
ness, deficient circulation of blood as is marked by the coldness 
of the extremities and dryness of the skin, arrest of the excretions 
in a more or less marked degree, perversion or loss of appetite, 
feeble digestion, more or less pain in back or head, and rest- 



Phenomena of Fever. 9 

lesness at night. These symptoms gradually increase until the 
next stage is ushered in. It will be noticed that these are just 
the effects described as resulting from the presence of a morbid 
material in the blood, and we further prove it by adducing as 
examples the eruptive fevers, and effects following dissecting 
wounds, or other absorption of decomposing animal material, 
in which these symptoms are invariably produced. 

Cold Stage. — With the continued increase of the morbid ma- 
terial in the blood, we have such depression of the nervous 
system, that there is no longer power to circulate the blood; 
congestion of parts near the center of circulation ensues, there 
is deficient oxygenation and capillary circulation in the skin, 
the result being constriction, coldness and involuntary motion. 
If vital force is so depressed that reaction can not take place, 
these effects increase and the patient dies in the second stage 
of fever, as we sometimes witness in congestive intermittents. 

Hot Stage. — We recognize in organized beings a certain 
conservative power which opposes the operation of noxious 
agents and labors to expel them when they are introduced. 
During the preceeding stages this power has been in abeyance, 
but now in order to prevent dissolution, it is concentrated 
to circulate the blood. The result is increased action of the 
heart and lungs, giving rise to the frequent pulse, return of 
capillary circulation to the surface, increased oxygenation, and 
consequent increase of temperature. The rapid circulation 
and oxygenation of the blood causes excitation of the nervous 
system; the concentration of the vis conservatrix to the circula- 
tion of the blood, in addition to the other effects named, 
accounts rationally for the arrest of secretion. 

Stage of Excretion. — If the hot stage has been proportion- 
ate to the others, equal circulation throughout the body having 
been established, and the deleterious material fitted for excre- 
tion, it terminates by the establishment of secretion from the 
skin, kidneys and bowels, and consequent return to health. It 
may take hours or days for the accomplishment of this end, 
but if the patient recovers it is accomplished. In intermittent 
fevers we may suppose that the stage of excretion is not com- 
pleted, that the blood is not entirely freed from the cause of 
disease; in such case after a certain length of time, we would 
have such inceased generation of the morbid material as to 
reproduce the fever. In remittent fevers, the object being but 



10 The Eclectic Practice of Medicine. 

partially accomplished by one revolution of the disease, there 
is but remission in the febrile reaction. 

Complications. — Owing to these marked changes in the cir- 
culation of the blood, we are surprised, not that local disease 
should ensue, but that its occurrence is so unfrequent. The 
stasis of blood in internal organs, impairs their functions and 
may lead to change of structure, while its rapidity and increased 
momentum in the hot stage, may, owing to the condition of 
the parts in the previous stage, occasion inflammation. The 
three first stages of fever are incompatible with the normal 
performance of the functions of the body. 

Division of Idiopathic Fever. — We may divide fever pri- 
marily into the two classes periodic and continued. The first is 
marked by distinct exacerbations and remissions, each occupy- 
ing a certain amount of time and recurring with great regu- 
larity. In the second, we have but one revolution of the fever, 
the hot stage being continuous for days or weeks until the dis- 
ease terminates in a stage of excretion and return to health, or 
in death. Periodic fevers we sub-divide into intermittent and 
remittent ; in the first the fever having made one revolution en- 
tirely ceases for a time, to again reappear in all its stages ; in 
the second we have but one cold stage, but the hot stage which 
succeeds it is marked by distinct intermissions of tolerably regu- 
lar recurrence. Continued fever is subdivided into synocha or 
sthenic fever, synochus or common continued fever, typhoid a 
fever with marked depression of vital power and depravation 
of the blood, and typhus a fever arising from animal infection, 
and characterized by a specific eruption. 

To these divisions we would add the exanthematous fevers 
which are produced by the absorption of a specific virus, which 
reproduces itself in the blood, and is finally determined to the 
skin. 



INTERMITTENT FEVER. 

Causes. — A majority of the profession concur in saying that 
intermittent fever is produced by the absorption of the gaseous 
exhalations of decomposing vegetable matter or marsh mias- 
mata. In proof of this position it is shown that this form of 
fever is endemic in those sections where vegetation is profuse, 
and the conditions necessary for rapid decomposition generally 
exist, and that in other sections where these conditions do 



Simple Intermittent Fever. 11 

not exist, it is not found. It is farther proven by the fact that 
in those sections where it is endemic, if the season is remark- 
ably wet or dry, so as to prevent vegetable decomposition, there 
is during such season but few if any cases of the disease. Any 
cause which will depress the vital power of the system, will 
predispose the patient to the action of this malarial poison. 

General Discription. — Intermittent fever might be consi- 
dered as a succession ot fevers occurring at regular periods with 
an interval of health between each. From the beginning of one 
of these to the commencement of the next, is termed a revolu- 
tion of the disease, which comprises a forming, cold, hot, and 
sweating stage, and the period of intermission. The type of 
the disease has reference to the length of these revolutions ; of 
these there are three principal and two minor — 1st. Where the 
disease makes a revolution in twenty-four hours it is termed a 
quotidian, the fever recurring every clay. 2d. The revolution 
occupying 48 hours it is said to be of the tertian type, the fever 
recurring every other day. 3d. Requiring 72 hours for a 
revolution, it is termed a quartan. 4th. There may be two 
revolutions in 24 hours, when it is said to be a double quotidian; 
and 5th. The disease recurring every day, but at different 
hours each day, the fever is called a double tertian : this distinc- 
tion is made because experience has shown that one of the 
paroxysms of fever may be arrested and yet the other will 
continue as a simple tertian. 

In some cases the fever continually recurs at an earlier hour 
in the day, it is then termed anticipating ague; in others it 
comes on later, and is called deferring ; and in others there 
being no regularity in its recurrence it is named erratic. 



SIMPLE INTERMITTENT FEYER. 

Symptoms. — Frequently, for some days preceding the mani- 
festation of the disease, the patient complains of listlessness, 
languor, indisposition to exercise, more or less derangement of 
the appetite and digestion, and torpor of the excretory organs ; 
we call this the forming stage. The cold stage is ushered in by 
a disire to yawn and stretch, sense of chilliness, desire to draw 
to the lire, more or less pain in the back, sometimes in the head, 
with increased thirst; chilliness increases, with trembling of 
the muscles, rigors and chattering of teeth; the pulse becomes 
excited, small and increased in frequency; capillary circulation 



12 The Eclectic Practice of Medicine. 

of the surface is diminished ; purplish appearance of nails ; 'skin 
of the extremities looses its natural healthy glow and color; fin- 
gers become smaller, so that rings drop off; countenance shrunk- 
en, lips blue or livid, with general contraction of skin, and pro- 
trusion of hair-bulbs giving that roughened appearance denom- 
inated cutis anserina; respiration is labored; tongue usually 
pale with slight whitish coat, dryness of mouth and insatiable 
thirst. In some cases there are no rigors — chilly sensations 
pass up and down the back and radiate over the body ; at last 
they are alternated with flushes of heat, which continue to 
become more intense until the hot stage is fully ushered in. 
Sometimes there is irritation of the stomach, with nausea and 
vomiting. This stage of the disease may last from a few 
minutes to four or five hours. 

The Stage of Reaction or Hot Stage is generally in inverse 
proportion to the chill, if it has been severe and long continued, 
febrile reaction is generally slight; if it is light and of short 
duration, febrile reaction is high. The sensation of coldness 
gradually disappears, respiration becomes free and regular, the 
pulse increases in strength, and is full, open, and less frequent, 
the skin becomes warm and capillary circulation free. Reac- 
tion does not stop here, but in a short time we find the 
temperature of the surface considerably increased, sometimes 
as much as 10°; the pulse increases in frequency to 100 or 
even 120 beats per minute, and is more open, full and bounding 
than in health, with more or less excitation of the nervous 
system, sometimes amounting to delirium. The secretions are 
all diminished — the mouth is dry and husky, tongue parched 
and cracked, sometimes coated with a white or yellowish fur 
and at others red, the skin is dry, harsh and constricted, urine 
scanty and high colored and does not deposit a sediment on 
cooling, and generally constipation of the bowels. This stage 
is of variable duration, from one or two, to twenty or twenty- 
four hours. 

As the Sweating Stage is ushered in, all the symptoms become 
ameliorated — the skin becomes soft, moist and natural, with 
sometimes profuse perspiration. The urinary secretion is 
increased in quantity, is less highly colored, and deposits a 
sediment. The pulse becomes natural, the heat has disappeared, 
and the patient enjoys comparative health. 

As will be seen, the diagnosis is readily made after the dis- 



Simple Intermittent Fever. 13 

ease has made one revolution, and the prognosis is always 
favorable. 

Treatment. — Our treatment is first directed to arrest the dis- 
ease, and second to prevent its return. The disease may be 
arrested, or in common parlance the ague broken, in several 
ways, but the means in most frequent use is the employment 
of certain agents, termed antiperiodics which are used during 
the intermission. Of these the chief and most reliable are the 
different preparations of Cinchona bark. Quinia Sulphas is a 
most reliable agent. I employ it in combination with the 
Prnssiate of iron which I think gives additional efficacy, as #. 
Quinine, gr. xv., Prussiate of Iron, gr. x., divide in three 
powders and give one every three hours during the intermis- 
sion, so that the last powder shall be taken one hour before the 
expected return of the fever. The proportions named may be 
considered the medium quantity to prevent the recurrence of 
the paroxysm, but will have to be increased or diminished 
according to the condition of the patient. If it does not suc- 
ceed the first time, repeat with increase of dose if there is 
nothing to contraindicate. This remedy having a nauseous 
taste, we find it necessary for the comfort of our patient, and 
many times essential to prevent its speedy ejection by the 
stomach, to disguise it. A strong infusion of cold, green tea, 
is a very good vehicle for its administration, as is also a weak 
solution of tannic acid, much of the bitterness being lost in 
both cases; or the remedy may be enveloped in gelatin capsules 
or it may be combined with an acid, as JL Quinia 3j., Aro- 
matic Sulphuric Acid, f3j., dose 3j., every two or three hours 
until the necessary amount is administered, or given in pills, as 
Tfc. Gelsemin, gr. v ; Quinia Sulphas, 3j ; Ferri-ferrocyanu- 
retum, gr. xx ; Ext. Piper Nigrum q. s.; make fifteen pills and 
give one every hour. 

We find cases occasionally in which this remedy will not be 
received by the stomach at all; these are most generally per- 
sons of a delicate, nervous habit ; here it may be used by enema 
or inunction, I prefer the latter. #. Quinia Sulphas 3j; 
Adeps, 3ij., mix; to be thoroughly rubbed into the axilla, groins, 
etc. ; this is especially a good way to use the agent in diseases 
of children. 

There are some cases in which from idiosyncracy of the 
patient the quinia produces severe excitation of the nervous 
centres, as is marked by headache, ringing in the ears, great 



14 The Eclectic Practice of Medicine. 

irritability, or in rare cases torpor of the entire system. In 
many of these, the reason of this will be found in some derange- 
ment of the stomach, which should be corrected, but in others 
we have to substitute other agents. Cinchonire Sulphas and 
Quinoidine may be sustituted for quinia in almost all cases 
except the last named, but they are not so efficient ; they are 
given in the same manner, medium quantity for arrest of disease, 
gr. xx. The Cerasine and Prunine ma} 7 be used advantageously 
in many cases, especially in the exceptional ones named. Me- 
dium quantity for arrest of disease, gr. xx, in three or four 
doses. The Salicine, Cornine, Piperine, etc., have been used, 
but are inferior agents The Euonymus Atropurpureus or 
Wahoo, taken in infusion has proven quite an efficient agent, 
and may be advantageously employed with the other remedies 
named. 

Intermittent fever may be arrested without the use of the 
class of agents named ; thus, a thorough emetic of Comp. 
Powder of Lobelia and Capsicum, given so that its action will 
be fully established at the expected time for the chill, will 
almost invariably prevent its recurrence that day; as will, also, 
the employment of the spirit- vapor bath with diaphoretics; 
or, in some cases, the use of the wet-sheet pack. The Extract 
of Juglans Cinerea, given in full cathartic doses, will also arrest 
the disease. This treatment, with the constant use of means to 
keep the excretions free, and bitter tonics to improve the quan- 
tity and quality of the blood, will effect a permanent cure. 

There are some cases, in which there being great torpor of 
the bowels, it is necessary to precede the antiperiodics with a 
cathartic; Podophyllin and Leptandrin, well triturated, are 
efficient agents. In other cases, there being a slow and lan- 
guid circulation, with general torpor of the excretory organs 
and especially of the stomach, an emetic will prove advan- 
tageous. 

In order to prevent a return of the disease it will be neces- 
sary to continue the antiperiodics, in smaller doses, for two or 
three days after the fever has been arrested, and it is well to 
repeat them every seventh day for three or four weeks. The 
excretions should be kept free — that from the skin by an occa- 
sional bath ; that from the kidneys by the use of the saline 
diuretics, say of Acetate or Citrate of Potassa, bj to 3ss, twice 
a day, with the occasional use of a mild cathartic if the bowels 
should be constipated. The employment of some bitter tonic, 



Inflammatory Intermittent Fever 15 

with a soluble preparation of iron, should be continued until 
the appetite and digestive power is restored, and there is a 
complete return to health. 

INFLAMMATORY INTERMITTENT EE^ER. 

The term inflammatory is employed here to denote a high 
grade of febrile action, and not the presence of inflammation, 
though this form of intermittent is probably more frequently 
complicated with inflammation than either of the others. 
This fever occurs more frequently in winter and spring than 
in autumn. The additional symptoms that characterize the 
disease are: a less marked cold stage, a much more violent 
febrile reaction, with great excitation of the nervous system, 
frequently delirium, and more marked arrest of the secretions. 
We notice during the hot stage, which is of longer duration, 
that the skin is dry, hot, and constricted ; urinary secretion 
very scanty and high colored; bowels obstinately constipated; 
the mouth dry, tongue coated white, and a hard resilient 
pulse. 

The most marked difference, however, is in the sweating 
stage, which is incomplete, and in the intermission, which is 
not perfect; the pulse still retaining an unnatural hardness, 
the skin being dry, urinary secretion still scanty, considerable 
thirst, with marked irritability of the nervous system. 

Additional Treatment. — As will be noticed by examining 
the above symptoms, the indications are, to lessen the force and 
frequenc} 7 of the heart's action, relax the system, and promote 
a normal stage of excretion; and, in many cases, these will 
have to be fulfilled before antiperiodics can be used with 
advantage. If we see the patient during the hot stage, the 
administration of sedatives and the frequent use of the alka- 
line bath (cold) or the wet-sheet pack will lessen the fever, 
shorten its duration, and favor more perfect secretion. Of the 
direct sedatives, the Veratrum Yiride and Aconite are the 
best. 1 frequently administer them together, as #. Tinct. 
Veratrum, f3j ; Tinct. Aconite, f3ss; Water, fjvj ; mix, and give 
the patient a teaspoonful every half hour or hour until the 
pulse becomes normal in frequency and its hardness disappears, 
then continue in smaller doses to keep up the effect until the 
disease is permanently arrested. If secretion is not estab- 
lished with these means, as soon as the pulse is reduced follow 



16 The Eclectic Practice of Medicine. 

with some diaphoretic infusion and the saline diuretics, keep- 
ing the bowels in a soluble condition and using the alkaline 
bath. The nauseant emetics may be used to produce sedation; 
for instance : fy. Asclepias Tuberosa, Eupatorium Perforatum, 
da 3j; Sanguinaria Canadensis, 3ij ; Nitrate of Potassa, 3'ij ; 
mix : during the fever give in doses of gr. xx every two hours, 
with Tinct. Gelseminum sufficient to produce its specific effect, 
and when the fever begins to disappear increase the dose of the 
first until free secretion is established. After fulfilling these 
indications the antiperiodics will invariably prove successful. 



GASTRIC INTERMITTENT FEYER. 

This variety is characterized by predominant disease of the 
gastro-intestinal mucous membrane and associated viscera. We 
notice two conditions especially : 

First — The tongue is broad and flabby, or broad and thick- 
ened, pale, and more or less heavily coated at base with a yel- 
lowish dirty mucus, with a bad taste in the mouth and 
frequent sensation of nausea. The appetite is impaired, diges- 
tion feeble, bowels constipated, with clay-colored evacuations 
w r hen moved ; the skin is sallow, flabby or puffy, with cold- 
ness of extremities ; the urine is normal in quantity, but pale, 
turbid, frothy, and of low specific gravity ; the patient has no 
desire for exercise, feels torpid, and has frequently a dull, 
heavy headache. The cold stage is generally marked, and of 
long duration; reaction is not very high but frequently pro- 
tracted, occasioning much suffering. In many cases there is 
nausea, with ineffectual attempts to vomit, in both stages. 

Second — There is much gastro-intestinal irritation; the 
tongue is somewhat contracted and pointed, coated in center, 
and edges reddened ; there is frequently a bitter taste in the 
mouth with sense of nausea, and tenderness on pressure over 
the epigastrium. The skin is constricted and wears a jaundiced 
appearance; the bowels but slightly constipated, with some- 
times alternations of diarrhea, when the disease is of long 
duration, and the urine is frequently colored with bile during 
the cold and hot stage. Febrile reaction is generally high and 
attended by more or less delirium. 

In both cases, if the disease is of long duration, the patient 
becomes cachectic ; there is frequently enlargement of the 
spleen or ague-cake, disease of liver, dyspepsia, and much 



Gastric Intermittent Fever. 17 

irregularity of the bowels even after the fever has been 
arrested. 

Additional Treatment. — In either of these eases it is of but 
little avail to use antiperiodics until we have at least partially 
removed the complication. In the first case, the treatment 
should be commenced by the administration of a prompt and 
thorough emetic, which may be repeated every second or third 
day, until it overcomes the torpor of the stomach and checks 
the too abundant secretion of mucus. To overcome the tor- 
pidity of the liver and bowels, small doses of Podophyllin and 
Leptandrin or infusion of Leptandra or Podophyllum are 
efficient. To assist in overcoming the condition of the bowels 
named, and to get normal secretion of urine, I employ Acetate 
of Potassa in doses of from 9J to 3j, three times a day. Especial 
attention should be paid to the skin by the frequent use of a 
tonic and stimulant bath: an infusion of equal parts of 
Hydrastis and Quercus Alba, with the addition of Alcohol or 
Tinct. Capsicum, answers a very good purpose. 

In the second case we wish to first arrest irritation of the 
stomach, bowels, and liver. For this purpose counter-irrita- 
tion over the epigastrium and right hypochondrium is import- 
ant; the frequent application of a sinapism answers in recent 
cases, but when of long duration I use the irritating plaster. 
In the use of the last named means, it is not necessary in a 
majority of cases to produce suppuration ; apply it until it 
raises a small crop of pustules, then remove it and reapply in 
twenty-four or forty-eight hours when the irritation has dis- 
appeared. Internally, an infusion of Peach-tree Bark and Dios- 
corea equal parts, followed by Hydrastis, is very effectual ; if 
there is much irritation of the liver with hypersecretion, small 
doses of Leptandrin and Opium or other agents of a similar 
character are indicated. The saline diuretics will be found 
very important agents in this case, given in small doses, as 
will also the special sedatives. 

Frequently an irritation of the gastro-intestinal mucous mem- 
brane will be continued by retention of acrid fceces, the bow- 
els not being thoroughly evacuated, even though the patient 
is suffering with diarrhoea. Where such is the case, a mild 
but thorough cathartic is important. If the irritation of the 
bowels is great, with colicky pain preceding and attending the 
discharges, the free use of demulcents, with demulcent and 
narcotic enemas, are sometimes beneficial. Again, there are 
2 



18 The Eclectic Practice of Medicine. 

cases in which it is impossible to check the irritation by any 
of the means named, in which we resort to an emetic, 
repeated as often as may seem necessary, using such measures 
as will thoroughly arouse the secretions. 

In this form of the disease as in others, we depend upon the 
antiperiodics to arrest the paroxysms, and yet there are very 
many cases in which their influence is but temporary. For 
a radical cure, we must in addition use such means as will 
stimulate and keep up secretion from the skin, kidneys, and 
bowels, and restore tone to the entire system. 



MASKED INTERMITTENT. 

The name, Masked Intermittent, is applied to those diseases 
which, while presenting but few or none of the symptoms of 
fever, are yet distinctly periodic in their nature. Almost every 
disease known may have a periodic complication and require 
a treatment adapted to intermittent fever. 

Periodic Neuralgia is, perhaps, the most frequent of the 
masked agues. We find a patient with a severe headache or 
pain in the face, which occurs regularly every day or every 
second, third, or fourth day, or is sometimes erratic in its recur- 
rence. | It resists the common means of cure, but readily 
yields to quinia and iron. The rule is, that any disease, no 
matter what its location or character, that is distinctly periodic in 
its recurrence, should be treated icith antiperiodics. Even when, 
as in inflammation, they do not arrest the disease, the removal 
of this periodic complication so modifies it that it readily 
yields to other treatment. 



CONGESTIVE INTERMITTENT. 

CONGESTIVE chill. 

Symptoms. — There is considerable discrepancy among writers 
in regard to the symptoms of this disease. I will describe it 
as I have seen it, and from descriptions sent me from physi- 
cians in the South West. In some cases, the congestive chill 
is preceded by one or more paroxysms of simple intermittent 
fever; in others, the first chill presents marked evidence of 
congestion. 

In mild cases, the cold stage at first presents no unusual symp- 
toms : but in an hour or two we notice that the temperature of 



Congestive Intermittent. 19 

the surface is markedly diminished ; the prostration of strength 
is unusual ; the patient is lethargic, and sensibility greatly 
diminished; he complains of giddiness, heaviness, pain, and 
sense of weight in his head; all the functions of the body are 
more or less impeded. In some cases the symptoms are 
extremely severe, in others there is nothing but a sense of 
deathly coldness. The skin at first contracted becomes relaxed, 
and frequently covered with a clammy perspiration. The pulse 
at first increased or normal in frequency, becomes slow, -50 or 60 
beats per minute, and is weakened and oppressed. This stage 
continues from four or five to twelve or more hours. 

Reaction comes up slowly, flushes of heat pass over the body, 
sensibility increases, the mind is less confused, the pulse 
increases in frequency and strength, but is still labored, and 
the surface gradually becomes warm. Finally the secretions 
become partially established and the paroxysm is at an end. 
In some cases marked febrile reaction with delirium, succeeds 
the cold stage, but this is rare. 

In some cases the symptoms named in the cold stage are all 
aggravated. From the first there is a peculiar besotted expres- 
sion of the countenance, and the patient is undecided and care- 
less as to the result. There is also marked loss of strength, 
and inability to command the voluntary muscles, so that if he 
attempts to walk he staggers like a drunken man. The cold- 
ness gradually increases until it becomes extreme ; sometimes 
there are severe rigors, at others none. The pulse is almost 
invariably slow, feeble and oppressed. The tongue is broad, 
flabby, and protruded with difficulty ; sometimes nausea and 
vomiting in the early stage ; frequently a disagreeable sense of 
tension in the epigastric region ; the respiration is short and 
weak, and the patient frequently complains of great oppres- 
sion in the precordial region. 

As the disease advances, the confusion of the intellect 
increases ; coma comes on ; the patient lies upon his back with 
tendency to slip down to the foot of the bed ; breathing is 
more difficult ; pulse small, weak and fluttering, or is inter- 
mittent, trickling under the finger like drops of water, and at 
last can not be felt at the extremities ; a cold clammy perspiration, 
sometimes foetid, covers the body ; the face assumes a leaden 
hue ; the lips are contracted over the teeth, and the patient 
dies, reaction not having taken place. 

In some cases a sero-sanguineous diarrhoea occurs ; in others 



20 The Eclectic Practice of Medicine. 

there is colliquative hemorrhage from various parts, with 
petechia. Occasionally there is nausea and vomiting, at last 
of dark, grumous, broken down blood ; sometimes there are 
convulsions. 

Diagnosis. — The diagnosis of a severe case of congestive 
intermittent is easy even at the commencement. The torpor 
of the nervous system, loss of voluntary motion, and slowness 
and oppression of the pulse are sufficient symptoms. 

Post-Mortem Examination. — Evidences of congestion of 
internal organs is very apparent. The vessels are engorged 
with dark blood, sometimes very much broken down. The 
digestive mucous surfaces are frequently altered ; often soft- 
ened and injected with dark blood in patches or spots. The 
lungs, liver and spleen are frequently found congested; the 
two last being sometimes considerably enlarged. 

Prognosis. — In severe cases it is thought that not more than 
one per cent would recover unaided, still if proper means are 
employed before the congestion becomes extreme, the progno- 
sis may be considered favorable. 

Treatment. — The first indication in the treatment of the dis- 
ease is to effect reaction, which is accomplished by the employ- 
ment of general and local stimulants, and means to overcome 
the extreme prostration of the nervous system. The second, 
to prevent the recurrence of the attack. 

To fulfill the first, energetic means must be adopted — such 
as will overcome the congestion and promote the general cir- 
culation. To determine the circulation to the surface, Mustard 
friction, or a sponge bath of diluted Tincture of Capsicum, or 
other stimulants, with brisk friction with the hands, will be 
sufficient in mild cases. When, the attack is severe, however, 
I direct a kettle of water to be put on the lire, and add of 
Mustard or Capsicums sufficient quantity to render it strongly 
stimulating, then when hot, w r ring a blanket out of it, apply- 
ing it to the patient, covering him warmly, and applying bot- 
tles of hot water, hot brick or irons, or any thing that can be 
obtained that will retain heat, to all parts of the body. Or 
instead, a tub of water may be heated, Capsicum and Mustard 
added, and the patient placed over it so that the vapor will 
reach every portion of his body ; then placing in the water 
hot stones, bricks or iron, the hot vapor will be made to 
envelop the entire surface, and will be a most efficient means 
of stimulation. 



Congestive Intermittent. 21 

If there is nausea, with weight and tension at the epigastrium, 
a stimulating emetic should be immediately administered : 
equal parts of Compound Powder of Lobelia and Capsicum, 
and Mustard, answer a very good purpose. If this is not 
necessary, we administer first, a strong topical stimulant to 
warm the stomach and promote circulation in it; as the Com- 
pound Tincture of Cajeput in teaspoonful doses every Hve or 
ten minutes, or a strong infusion of Capsicum or its tincture, 
until a sensation of warmth is felt in the stomach. In many 
cases the patient's life depends upon these means, for the stomach 
is so torpid and its circulation so sluggish, that without them, 
no absorption of any remedy will take place. Thus in a j)ost- 
mortem examination of a case of congestive intermittent, made 
by me, nearly the entire amount of Quinia taken, was found 
in the stomach and duodenum. 

The means named, though of the highest importance, are 
only preparatory for the remedy upon which we place the 
greatest reliance. In fifteen or thirty minutes, or at farthest 
an hour, we will find that the internal stimulants are having 
their effect, when we commence the employment of Quinia. 
The dose of this agent depends upon the severity of the case; 
when mild, gr. x, repeated every hour or two, until reaction 
ensues, will be sufficient; the greater the prostration and tor- 
por, the larger should be the dose, until in extremely severe 
cases it has been administered in 3j doses every hour with the 
happiest effects. I have administered in one case, 3ss in four 
hours, without the slightest injurious effect. The general 
stimulant should be continued in smaller doses during the 
administration of the Quinia. 

After reaction is established, we use means to restore all the 
secretions, and here I do not wish to be understood as recom- 
mending means that greatly stimulate the excretory organs, 
because such stimulation almost invariably results in prostra- 
tion and an arrest of secretion. Remedies that act mildly are 
the ones required. Then administer the requisite quantity of 
antiperiodics, (Quinia is the only agent that can be depended 
upon in this case,) to prevent a recurrence of the attack. The 
quantity of Quinia, as a general rule, will have to be larger 
than in simple intermittent, say from gr. xx. to 3ss. during the 
intermissions. It is a good plan to put the patient upon the 
use of the Extract of ISTux Vomica, in doses of about one-sixtl 



22 The Eclectic Practice of Medicine. 

of a grain every four hours, after reaction is established, espe- 
cially if the circulation is feeble. 



REMITTENT FEVER. 

i 

BILIOUS FEVER. 

Remittent Fever, differs from the Intermittent, in that it 
consists of but one perfect revolution of the disease, the hot 
stage being greatly prolonged, but exhibiting well marked 
remissions and exacerbations. Like intermittent fever, it is 
supposed to be caused by what is generally termed marsh 
malaria, though there is no doubt but that sudden atmospheri- 
cal vicissitudes and changes of temperature, by arresting secre- 
tion, impairing nutrition, and lessening the vital power of the 
individual, may form a cause of the disease. It occurs princi- 
pally in the fall, though many cases are seen through the 
summer, and even during the entire year. It also differs much 
in its character, being mild in high and temperate regions, and 
severe in low, marshy, and warm countries. 

Symptoms. — The forming stage usually occupies some days, 
the symptoms being gradually developed. At first, there is 
nothing but a feeling of weariness, especially upon slight 
exertion. This languor increases, and is accompanied with 
listlessness, or indisposition to make any exertion ; the appetite 
becomes capricious, with a bad or bitter taste in the mouth ; 
tendency to nausea, with, sometimes, vomiting ; the bowels 
are costive, and skin dry, and more or less pain and heaviness 
in the head, with, frequently, pain in the back and limbs. 

Cold Stage. — The attack is sometimes ushered in by a well 
marked chill or rigor, closely resembling the cold stage of an 
intermittent. Frequently the chill is very slight, and again, 
merely a sense of coldness ; or slight chilly sensations pass over 
the body, which after a short time are succeeded by flushes of 
heat, these alternate, the chills becoming less and less marked, 
until, finally, febrile reaction is set up. In some cases, espe- 
cially those in which the chill is marked, nausea comes on, and 
finally, vomiting, about the time reaction sets in. Sometimes 
there is some pain in the back and limbs during this stage of 
the disease. The cold stage usually lasts but a short time, one 
or two hours, but is occasionally protracted. 

Hot Stage. — When reaction ensues, the pain in the back, 
head, and limbs, increases, being in some cases extremely severe. 



Remittent Fever. 23 

The temperature of the surface is markedly increased, the skin 
being dry and constricted, the face flushed and turgid, and the 
eyes red and suffused. The pulse is full and frequent, rarely 
tense, and the respiration hurried and uneven. The tongue is 
covered with a yellowish-white fur, with, frequently, a dis- 
agreeable taste in the mouth, and more or less nausea, with 
oppression and pain in the epigastrium, and in many cases, severe 
and protracted vomiting of bilious matter. All the secretions 
are checked — the bowels costive, and the urine scanty and 
high colored, sometimes loaded with bile which gives it a yel- 
low tinge. The nervous system in many cases, is considerably 
deranged, the patient being watchful and very restless. There 
is rarely delirium in the first exacerbations, more frequently a 
marked dullness and torpor. 

These symptoms continue from eight to twenty hours, when 
they gradually pass off; the heat of the surface is diminished, 
with frequently slight perspiration about the neck and face; 
the pulse is not so frequent, the pain in head and back ceases, 
and the patient feels comparatively comfortable and sometimes 
takes a refreshing sleep. This constitutes the period o£ remis- 
sion which in a majority of cases occurs once in twenty-four 
hours, usually in the morning, though in some Ijiere is two 
per day, in others, a more complete remission occurs every 
second or third day. 

This remission varies greatly in its duration and complete- 
ness in different cases, in some it is long and amounts almost 
to an intermission, in others, it is short and the febrile symp- 
toms but slightly abated. Following it, the febrile symptoms 
reappear with all their first intensity, and the hot stage con- 
tinues to the end of the disease, in a succession of exacerbations 
and remissions. 

In some cases of this fever, we do not observe that the febrile 
reaction becomes more intense as it progresses, but in others, 
each succeeding exacerbation is more marked, the remission 
shorter and less noticable, until finally, the fever is nearly or 
quite continuous. The irritation of the stomach continues 
often for two, three or four days, in some cases, through the 
entire disease, if not arrested by remedies. 

As might be supposed, the patient's strength fails day by 
day, innervation and secretion becomes more and more 
impaired, until by the seventh or eighth day we find him in 
one of two conditions. The fever having lost its original type, 



24 The Eclectic Practice of Medicine. 

has become an adynamic continued fever, with typhoid symp- 
toms. Or the patient's strength having become greatly ex- 
hausted, we observe a want of reactive power, there is a ten- 
dency to congestion during the remissions, at which time the 
surface becomes cool, sometimes covered with a clammy per- 
spiration, the pulse is small, weak, intermittent, and respira- 
tion short, quick, and difficult; coma makes its appearance, 
the patient lies upon his back, slips toward the foot of the 
bed, there is a jactitation, picking of the bedclothes, and after 
one or more unsuccessful attempts at reaction the patient 
dies. In this last case, the disease terminates fatally as a remit- 
tent ; this, however, is a rare termination, for if not arrested dur- 
ing the first week it generally assumes a continued form, and 
presents all the symptoms of a continued fever. 

In warm climates, as has been already remarked, the disease 
is more intense. When reaction comes up the skin is intensely 
hot, dry, and husky ; the eyes suffused, of a muddy yellowish 
hue, often dull and languid; there is intense pain, and sense 
of insupportable weight in the head, with frequent extreme 
pain of back and extremities ; the pulse is quick, frequent, 
more or less tense, and the respiration hurried and difficult. 
If the disease is not arrested early the remissions disappear, 
the skin becomes dry and rough, or moist and clammy, the 
tongue black and crusted, with much irritation of stomach, 
the pulse small and irregular, low muttering delirium comes 
on, and the patient dies. 

Complications. — Remittent fever is frequently rendered diffi- 
cult to treat by the existence of some local affection. Irrita- 
tion of the stomach and duodeum is probably the most fre- 
quent complication ; the symptoms are continued nausea and 
vomiting, tenderness on pressure over the epigastrium, with a 
feeling, frequently, of insufferable oppression in that region. 
Determination to the brain is also met with in the severer 
forms of the disease ; indicated by, first, symptoms of cerebral 
excitement, followed by stupor, low delirium and coma. Dis- 
ease of the liver is also of frequent occurrence in warm climates, 
most frequently manifested by symptoms of irritation, and in- 
creased secretion of acrid bile, which produces irritation of 
the bowels, but sometimes of congestion, the secretion being 
arrested. Various pulmonary affections are met with in this dis- 
ease, especially bronchitis and pneumonia, of a congestive form. 

Post-Mortem Examination — The liver has usually been 



Eemittent Fever. 25 

found injected, softened, of a dark color and friable ; the spleen 
enlarged and softened ; the digestive mucous surfaces dark, 
discolored, ecchymosed, softened, sometimes thickened, or 
ulcerated. The blood is dark, fluid, and more or less broken 
down, and if the disease has been severe, frequently extrava- 
sated into the tissues. 

Diagnosis. — The character of the fever is easily determined 
after it has made one revolution, the remission recurring daily, 
serving to mark the diagnosis, still we frequently find cases in 
which from some complication, or the original severity of the 
disease, the remissions are very obscure, when the diagnosis 
will be difficult. The j^ognosis is generally favorable. 

Treatment. — In this, as well as in other diseases, it is of the 
first importance, that any derangement of the stomach and 
bowels should be immediately corrected. If, therefore, we find 
our patient suffering from nausea, with ineffectual efforts to 
evacuate the stomach, we would administer a thorough and 
efficient emetic of Compound Powder of Lobelia and Capsi- 
cum. If there is redness of the tip and edges of the tongue, 
with tenderness on pressure over the epigastrium, counter-irri- 
tation, with agents to quiet irritation of the stomach would 
be indicated; as an infusion of Peach tree Bark, or that and 
Diascorea, equal parts, or an infusion of Compound Powder 
of Rhubarb and Potassa, with sometimes the addition of small 
portions of Morphia. I have found the irritation of the stomach 
and bowels yield in some cases to the Essential Tincture of 
Asclepias, and' small doses of Veratrum. 

The next indication is, to reduce the force and frequency of 
the heart's action, induce relaxation, and gain a better remis- 
sion for the administration of antiperiodics. I now use the 
special sedatives to accomplish this purpose, giving them in 
small doses, frequently repeated, and largely diluted with water, 
as £. Tinct. Veratrum Vir. f3j., Tinct. Aconite, Pad. f3ss., 
Aqua gvj., administered in teaspoonful doses every hour, or half 
hour, until the desired result is produced. If an emetic has 
been administered, we find that continuing it in small doses, 
with the use of the hot foot-bath, and alkaline sponge bath, 
will produce indirect sedation and answer in place of the direct 
sedatives just named. Or sedation may be effected by the use 
of the vapor, or spirit- vapor bath, and the stronger diaphoretics. 

The means just named will mitigate the sufferings of the 
patient, shorten the febrile exacerbation, and occasion a 



26 The Eclectic Practice of Medicine. 

longer and better remission. As the fever commences to de- 
cline we resort to mild diaphoretics, as the Compound Powder 
of Ipecac, and Opium, Asclepias, etc., and the saline diuretics, 
as the Acetate, Citrate, or Nitrate of Potassa, to increase secre- 
tion. During the remission, it is desirable to administer a 
sufficient amount of some anti periodic to arrest the disease. 
Quinia is the most efficient agent. I generally combine it 
with the Prussiate of Iron, as in intermittent fever. It is 
usually better to commence its administration as the fever is 
declining ; divide the amount necessary into three doses, and 
give them two hours apart, so that the last one will be taken 
at least half an hour previous to the expected exacerbation. 
The sedatives, diaphoretics, and diuretics, should be continued 
through the remission. 

If the fever again rises, we stop all but the special sedative, 
continuing it until the fever commences to decline, then com- 
mence again with agents to promote secretion, and an in- 
creased dose of the antiperiodic in the remission ; Opium to 
induce sleep is indicated, when the patient's rest has been bro- 
ken. In some cases, three, four, or five revolutions of the 
disease will be made, before we are able to arrest it, but we 
notice, even in this case, a perceptible mitigation of the disease 
from the treatment. 

In some cases, there is great torpor of the bowels, even 
when the stomach is irritated, and the retention of foecal mat- 
ter and arrest of secretion increases the intensity of the fever. 
A mild but thorough cathartic will be beneficial, sometimes 
relieving the irritation of the stomach as soon as it operates. 
In the progress of the disease cathartics are not generally 
useful, but the bowels should be kept in a soluble condition 
by the administration of gentle laxatives. 

If there is determination to the brain, the Tincture of Gelse- 
minum should be administered with the direct sedatives in 
doses sufficient to produce its specific infiuence upon the sys- 
tem, with counter-irritation to the extremities and spine. If 
there be much nervous excitation, with pain in the back and 
limbs, the patient being uneasy and restless, the Tincture of 
Macrotys will be found a valuable remedy. If the coating of 
the tongue becomes dark early in the disease, I replace the 
preparation of Potassa named, with the Chlorate, giving it in 
doses of about five grains every three or four hours, with Tur- 
pentine ten to twenty drops. In the latter stages of the 



Congestive Remittent Fever. 27 

disease we treat it as we would a typhoid fever, recollecting, 
however, that if a remission can be produced, large doses of 
Quinia at that time may arrest the disease at once. 



CONGESTIVE OR MALIGNANT REMITTENT FEVER. 

This form of remittent fever occurs most frequently in the 
South and Southwest, and sometimes proves extremely fatal. 
It is characterized by marked adynamia, congestion of impor- 
tant organs being its prominent feature. 

Symptoms. — The cold stage is usually short and not very 
severe, but the patient is dreamy and drowsy; the counten- 
ance is somewhat swollen, the look is vacant; the respiration 
oppressed and labored, and the pulse small and scarcely to 
be felt. There is, frequently, nausea and vomiting, with 
faintness, and sometimes diarrhoea. 

Reaction comes up slowly, the pulse being small and 
weak, though frequent, and the anxiety and sense of 
weight at the prsecordia increases. The temperature of 
the surface is but little increased, and that only about the 
trunk, the extremities being frequently cold. During the 
remission the pulse becomes very feeble and slow, the surface 
cold, the extremities livid, and the patient covered with a 
clammy perspiration. There is great torpor, the patient being 
aroused with difficulty, frequently coma makes its appearance 
during the first remission. These symptoms of congestion 
increase at each remission, until, finally, reaction ^can not be 
accomplished, and the patient dies. This has been termed 
the cold plague. 

Again, there are cases in which the first reaction is ex- 
tremely violent, the pulse is corded and frequent, the skin is 
hot, dry, and husky, great thirst, entire arrest of secretion, 
excruciating pain in the head, back and limbs, dyspnoea, and 
distressing oppression at the epigastrium. A short remission 
occurs, when again the febrile reaction comes on with in- 
creased intensity. This continues for two or three days, when 
a remission like that described above occurs, marked by great 
congestion, and consequent oppression of the vital powers, 
from which the patient never reacts, but dies in the stage of 
remission. 

Treatment. — In the first case named, it is all important that 
such means should be used as would speedily remove conges- 



28 The Eclectic Practice of Medicine. 

tion, equalize the circulation, and overcome the depressed 
condition, of the nervous system. A stimulant emetic has 
.been employed at first by many of our practitioners in the 
South with advantage, an infusion of Compound Powder of 
Lobelia and Capsicum, is administered with simple Capsicum 
or Black Pepper Tea, the last being considered preferable. 
Emesis should be thorough and prompt, when it is almost 
always followed by normal return of circulation to the surface 
and extremities. At the same time the entire surface should 
be sponged with a decoction of Capsicum in vinegar, and heat 
applied to the patient warmly covered in bed. If further 
stimulation appears necessary, Tincture Xanthoxylum, Com- 
pound Tincture of Cajeput, or brandy punch is freely given. 
Counter-irritation to the spine is especially indicated, and 
sinapisms should be applied to the surface over internal organs 
that are suffering most from congestion. These means are 
preparatory to the administration of Quinia, which should be 
given in doses of at least five grains every three hours until 
innervation is completely re-established, when the case is 
treated as a common remittent fever. 

In the second instance, the high reaction is controlled by 
the special sedatives, and the extreme irritation of the cere- 
brospinal centres, b} 7 counter-irritation, and the administra- 
tion of Tinctures of Gelseminum and Macrotys. The anti- 
periodic in this case must be given in large doses, and will 
have to be commenced immediately after the fever commences 
to decline; 3ss. of the agent is usually considered about the 
amount necessary. Remedies to increase secretion are indi- 
cated, as in common remittent fever, and complications must 
be treated as they arise. 



YELLOW FEVER. 

Yellow fever is a disease of warm climates, prevailing prin- 
cipally in the torrid, and southern part of the north temperate 
zone. It is evidently closely allied to remittent fever, as it 
prevails in those sections, and those only, which are regarded 
as malarious. It makes its appearance in an epidemic form in 
the latter part of summer, and ceases its ravages with the first 
frosts. For its production it appears to be necessary, that the 
causes of vegetable malaria shall exist with intensity; that 
there shall be more or less decomposing animal matter, with 
a high range of heat for many days consecutively. Certain 



Yellow Fever. 29 

sections of country appear to possess all the elements for the 
generation of the disease, and hence it makes its appearance 
with great regularity at such period of the year, as gives the 
necessary high and long continued heat for decomposition. 

Persons who have long resided in those sections, have usu- 
ally an immunity from the disease, which is doubtless owing 
to such gradual change in the constitution as enables it to 
throw off the malarial poison : such persons are said to be 
acclimatized. Persons from the north, or sections free from 
these malarial poisons, residing in a country where yellow 
fever prevails, are most liable to the disease. It is generally 
admitted that it is not contagious, at least not more so than 
other fevers where decomposition is speedily set up after death, 
or even before dissolution, as in typhus, and some cases of 
typhoid fever. There can be no doubt that the emanations 
from such persons are poisonous to those whose vitality has 
been impaired, and that if absorbed they will give rise to ady- 
namic fever. 

Symptoms. — Yellow fever may be divided into three stages, 
which in many epidemics are well marked, but in others are 
indistinct. These are, first, a stage of primary fever, lasting 
from thirty to seventy hours ; second a stage of remission ; and 
third a stage of collapse. 

First Stage. — This stage, is sometimes preceded for some 
hours or claj's, with the usual prodromal symptoms of fever. 
Languor, listlessness, failure of appetite, and more or less pain 
in head, back, and limbs. Chilliness precedes febrile reaction 
in a majority of cases, though a well marked cold stage is 
rare. With the development of febrile reaction, the skin 
becomes hot, dry, and harsh ; the urinary secretion is arrested, 
and the bowels are obstinately constipated. The patient suffers 
severely with pain in the back, limbs, and head, and is extremely 
restless and uneasy. Much irritation of the stomach exists 
from the first, with pain and sense of oppression in the epi- 
gastrium ; in a majority of cases vomiting speedily comes on 
and continues through this stage — the retching and ejection 
from the stomach being painful and difficult. The eyes are 
generally suffused, redened, and very sensitive to light, pre- 
senting the appearance that would follow exposure to wood 
smoke ; this has been looked upon as almost a pathognomonic 
symptom by some. The pulse varies greatly in different cases ; 
in many, it is hard, quick, and irregular, in others small, corded 
and oppressed, and in others not different from what it would 



30 The Eclectic Practice op Medicine. 

be in a simple remittent. The tongue hardly ever presents the 
same appearance ; sometimes clean, again broad, flabby, and 
covered with a thin white coat; again redened at tip and 
edges, pointed, and coated in the center; and again presenting 
a thick yellowish, or yellowish brown coat. As before 
remarked, this stage varies in duration, and there is just as 
much variation in its intensity. 

Second Stage. — The febrile action gradually abates; the 
vomiting ceases, or is less constant ; the pains are much ameli- 
orated; the skin becomes softened, and frequently covered 
with perspiration. The patient feels comparatively well, 
though exceedingly debilitated, and has hopes of speedy 
recovery, and yet, even now, may be noticed that yellowish 
discoloration, manifesting itself in the conjunctiva, and the 
skin of the forehead and breast, the precursor of that third 
stage, from which it is so difficult to recover. This remission, 
sometimes so complete, can hardly be noticed at others, but 
the first rapidly passes into the third stage, or collapse. It is 
always of short duration, not more than from two to ten 
hours. 

Third Stage. — In this stage the pulse becomes very feeble, 
and the prostration is excessive ; the yellow appearance of the 
skin, which gives the disease its name, becomes plainly visible 
and continues to deepen as the disease advances. The irrita- 
bility of the stomach is excessive ; nothing can be retained, 
but the vomiting now is easy. The material ejected from the 
stomach is peculiar, being very dark colored, and hence known 
by the name of black vomit : this dark colored material has 
been determined to be broken clown blood. Diarrhoea frequently 
ensues, the discharges from the bowels resembling that ejected 
from the stomach. The respiration is hurried and difficult, 
with frequent sighing, and the patient complains of an intol- 
erable oppression and distress at the praecordia. The powers 
of life rapidly fail ; slow delirium or coma comes on, and death 
soon eases the patient from his intolerable suffering. 

Post-Mortem Examination. — The scalpel invariably reveals 
necrcemia, or death of the blood, other lesions are but incidental 
or the result of complications. Sometimes the liver is enlarged, 
congested or softened, but at others it is contracted and brittle; 
the lungs are occasionally engorged, and blood is extravasated 
into their structure ; the brain is generally harder than usual, 
but the dura-mater has been found studded with small spots of 
coagulated blood, and the arachnoid covered with a deposit of 



Yellow Fever. 31 

coagulated lymph. The most common lesion of the solids, is 
softening of the mucous membrane of the stomach and bowels, 
with frequent dark discoloration. 

Diagnosis. — According to the statements of all authorities, 
it is extremely difficult, if not impossible, to distinguish yellow 
fever from the severer forms of remittent fever, in the first 
stage. Yet the prevalence of the disease as an epidemic in 
that locality, is considered sufficient cause to adopt a treatment 
suitable for its arrest, in every case presenting the symptoms 
named. The subsidence of the fever after the exacerbation 
has continued more than twenty-four hours, is a prominent 
evidence of the disease : the commencing yellow discoloration 
of the skin, great prostration, and finally vomiting of dark 
colored material, renders the diagnosis beyond cavil. 

Prognosis. — By our physicians in the South, the prognosis 
is considered favorable if the patient is seen during the first 
stage ; but if the disease has progressed to the third stage, the 
prognosis is considered unfavorable. 

Treatment. — The treatment adopted during the first stage, 
has for its object, the mitigation or arrest of the irritation of 
the stomach, an equal circulation of blood through the system, 
and a reduction of the intensity of febrile reaction, with con- 
sequent partial restoration of the secretions. 

By many it is considered that the gastric irritation is most 
efficiently removed by agents to overcome the obstinate con- 
stipation of the bowels, and stimulate the liver to increased 
action, thus promoting a free portal circulation. The favorite 
remedies with such, are #. Podopbyllin, gr. ss to gr.jss; Lep- 
tandrin, gr. ij to gr. v ; Potassse Bitartras, gr. v. to gr. x ; admin- 
istered at a single dose, with adjuvant means to quiet the stom- 
ach until the action of the cathartic. In the early part of the first 
stage, if the tongue is coated, with bad taste in the mouth, 
and sometimes ineffectual efforts to vomit, it is generally con- 
ceded that a thorough and efficient emetic should precede all 
other treatment, as it relieves the irritation of the stomach 
sooner and better, than any other plan of treatment. To 
equalize the circulation, the hot mustard foot bath is employed, 
and in severer cases, mustard friction to the entire surface ; 
the patient is placed in bed, covered up warmly and a w T arm 
infusion of the simple diaphoretics, of balm, sage, catnip, etc., 
given until free perspiration is induced. Counter-irritation to 
the stomach, bowels, spine, and extremities, is also employed. 
Sour lemonade is recommended as a drink, if the patient com- 



32 The Eclectic Practice op Medicine. 

plains of much pain. Tincture of Gelseminum in closes of 
gtt. xxv, every three hours, has been administered with 
advantage. 

As soon as the remission becomes manifest, antiperiodics are 
given: the following appears to.be the favorite combination: 
R. Quinia Sul., gv. x to gr. xv ; Elixir Vitriol, gtt. xxx to gtt. 
xl; Tinct. Gelseminum, gtt. xxx to gtt. 1; Syrup of Lemon, 
3j ; mix : to be taken at one dose : or, fy. Quinia Sul., gr. x to gr. 

xv ; Tannic Acid, gr. v; Tinct. Gelseminum, 3ss ; S}'rup of 
Lemon, 3 j ; mix, for a dose. Afterward Tinct. Gelseminum 
is administered in doses of f3ss every two or three hours, until 
four or live doses are taken. 

After this the treatment will have to be conducted on gen- 
eral principles, meeting the indications as they arise. The 
stomach must be kept quiet, diarrhoea arrested if it appears, 
the patient's strength kept up by the judicious use of stimu- 
lants and nutritious but easily digested food, and especially 
must normal circulation in the skin and extremities be main- 
tained, and free secretion from the kidneys. Convalescence is 
slow and must be managed with great care; any indiscretion 
in regard to diet or exposure tending to produce a relapse. 



SYXOCIIUS FEVER. 
(simple inflammatory fever.) 

It is exceedingly difficult to mark the dividing lines between 
the three divisions of continued fever, generally recognized by 
the profession. In fact, it is doubtful whether it would not 
be better to consider continued fever as a single whole, with- 
out attempting a division ; but as such divisions are gen- 
erally recognized, and may be studied with advantage by 
the student, I will attempt it. I may state in the commence- 
ment, that I am satisfied from personal observation and borne 
out by my authorities, that continued fever may commence as 
a synochus or simple inflammatory fever, and as it continues 
assume the form of synocha and at last terminate in well- 
marked typhoid. Xot only so, but it is well-known that a fever 
may commence as an intermittent, then become remittent, then 
continued, and finally the patient will die of confirmed typhoid. 
Thus Dr. Hosack remarks : " The typhus fever, as it appeared 
at "Wallkill, commenced as an intermittent, then became remit- 
tent, and at length ended in typhus." 



Synochus Fever. 33 

Causes. — The causes of synochus fever are, first, those that 
predispose the patient to disease; as high irritability and 
tonicity of fiber, with vascular fullness and imperfect perform- 
ance of the excretory functions. Atmospherical vicissitude 
is the common exciting cause. 

Symptoms. — This form of continued fever is generally sud- 
den, there being but few premonitory symptoms. The patient's 
attention is often first arrested by chilly sensations passing 
over the body, and a sense of dullness and languor. Some- 
times the chill is well-marked, in rare cases amounting to 
rigor, but often the sensation of cold is but slight. 

This chilliness is rapidly followed by reaction; the skin 
becomes injected, dry, hot, and burning; the countenance 
flushed and animated; the pulse frequent, full, strong, and 
bounding, rarely hard and oppressed ; respiration is frequent, 
the respired air hot, and the mouth and nostrils dry; the bow- 
els are constipated, and the urine scanty and high colored ; 
the tongue white, its papillae elongated and erect. The patient 
experiences great thirst, and manifests increased sensibility 
especially in regard to light and noise. There is frequently 
some headache, with sometimes vertigo, and the patient is 
watchful, restless, and uneasy. 

As the disease progresses these symptoms increase in sever- 
ity ; the secretions are still further arrested, the 'heat and dry- 
ness of the skin increase, and the patient is more watchful and 
uneasy. All the symptoms are usually more exasperated in 
the evening and early part of the night. The fever continues 
to increase in intensity until about the fifth or sixth day, when 
there is a tendency to a crisis, and the disease is frequently 
arrested by the establishment of secretion. If it progresses 
much beyond this period, we observe a manifest prostration, 
the symptoms being those of synochoid; and in the course of 
as many days more, marked evidence of disorganization of the 
blood and typhoid symptoms. We rarely, if ever, see the 
disease terminate fatally as an inflammatory fever, unless com- 
plicated with inflammation of some important organ. 

Complications. — The most frequent complication of this 
disease is inflammation of some part of the respiratory appa^ 
ratus, the symptoms of which are frequently obscured by the 
fever; this complication must be constantly watched for. 
Determination to, and inflammation of the brain, occurs in 
some cases ; but the symptoms developed will usually arrest 

3 



34 The Eclectic Practice of Medicine. 

the attention of the physician. Occasionally irritation of the 
stomach arises and renders the treatment difficult. 

Diagnosis. — The continued reaction determines the t}^pe of 
the fever; the marked evidence of excitation, little prostra- 
tion, and the full and bounding character of the pulse, showing 
great vital power, distinguishes it from synochoid and typhoid. 
The prognosis is favorable if no serious complication should 
arise. 

Treatment. — We notice two prominent indications in the 
treatment of this disease ; first, to reduce the force and fre- 
quency of the circulation and the irritability of the nervous 
system, and produce relaxation ; and, second, to obtain secre- 
tion from the principal outlets, the skin, kidneys, and bowels. 

Before the introduction of the special sedatives, the first was 
accomplished by the administration of nauseant diaphoretics, 
the use of the cold allusion, or spirit or other vapor baths, 
with frequently tfye administration of a hydragogue cathartic. 
We now accomplish the same end by the administration of the 
special sedatives. In this case, the Veratrum Yiride in small 
doses frequently repeated, with the addition of Gelseminum and 
Macrotys to relieve nervous irritation, will accomplish the pur- 
pose. The Tincture of Veratrum Yiride should be administered 
in doses from one to three drops every half hour or hour, with 
about ten drops of the Tinctures of each of the other two 
agents named. The surface should be frequently bathed with 
moderately cool water and some warm diaphoretic infusion 
given as a diluent. If there appears to be great vascular 
fullness it is best to administer at first a free cathartic, as Com- 
pound Powder of Jalap and Senna and Bitartrate of Potassa, da 
3ss ; which by producing free watery discharges from the bow- 
els will increase the effect of other remedies. This treatment 
will moderate the febrile reaction, and in from thirty to sev- 
enty hours we will find the pulse reduced to nearly a normal 
standard, the irritation of the nervous system subdued, and 
relaxation of the entire system, with increase of secretion. 

Then we commence the administration of diaphoretics and 
diuretics, still continuing the sedative, to keep up its influence. 
The mild diaphoretics produce the best results, as an infusion of 
Asclepias, Eupatorium, Polygonum, Pterospora, etc., or Ascle- 
pin and Comp. Powd. of Ipecac and Opium, equal parts. The 
action of these agents should be increased by the use of the 
hot foot bath. The saline diuretics, as the Acetate, Citrate or 



Synochoid Fever. 35 

Nitrate of Potassa, are the ones indicated, in doses of gr. xx, 
every four hours. Moderately free secretion from the skin and 
kidneys is thus obtained, and the system still further relieved. 
A sufficient dose of Opium to induce sleep is now very ben- 
eficial. This treatment, if there are no complications, should 
be continued until convalescence is established, and if properly 
pursued it will arrest the fever in from three to four days. 



SYNOCHOID FEVER. 

(common continued fever.) 

This form of fever occurs in persons of moderate strength 
of constitution, and when there has been no previous cause 
acting on the system to lower the vitality, or permanently 
derange the excretory organs, and the constitution of the 
blood. At its commencement we notice no symptoms of great 
impairment of the fluids, though should the disease continue 
long, such change in the blood will occur as to give rise to 
typhoid symptoms. This is the disease which in the major- 
ity of cases, has been designated as typhoid fever, because 
if allowed to progress, such symptoms became manifest; but 
more frequently because popular opinion regards the last- 
named fever as an exceedingly dangerous disease, and physi- 
cians like to claim the credit of curing it. I use the term 
typhoid in its literal meaning, " -resembling typhus" and apply 
it to those cases exhibiting marked loss of vitality, and com- 
mencing necreemia. If it was strictly used in this sense, we 
could understand better, perhaps, the treatment necessary to 
its arrest, at least, we would be able to attach some meaning to 
much that is written about typhoid fever. 

Causes. — The predisposing causes of this, as well as typhoid 
fever, are all such as occasion temporary exhaustion and 
want of power in the system to react and expel disease. The 
exciting causes are numerous: as an arrest of secretion, 
and retention of excrementitious material ; the absorption of 
exhalations from vegetable and animal matter undergoing 
decomposition ; animal miasms, as from healthy persons or 
animals crowded together, or confined in imperfectly ventilated 
situations, and without due regard to cleanliness ; from per- 
sons laboring under disease of any kind in ill-ventilated apart- 
ments. a Every population," says Mr. Chad wick, throws off 
insensibly an atmosphere of organic matter, excessively rare 
in country and town, but less rare in dense, than in open dis- 



36 The Eclectic Practice oe Medicine. 

tricts ; and this atmosphere hangs over cities like a light cloud, 
slowly spreading, driven about, falling, dispersed by the winds, 
washed down by showers. It is not vitalis halitus, except by 
origin, but matter which has lived, is dead, has left the body 
and is undergoing decomposition into simpler than organic 
elements. The exhalations from sewers, church -yards, vaults, 
slaughter-houses, cess-pools, commingle in this atmosphere ; 
and, notwithstanding the wonderful provisions of nature for 
the speedy oxidation of organic matter in water and air, accu- 
mulate, and the density of the poison (for in the transition of 
the decay it is a poison,) is sufficient to impress its destructive 
action on the living, to receive and impart the processes of 
zymotic principles, to convert by a subtle, sickly, deadly 
medium, the people agglomerated in narrow streets and courts, 
down which no wind blows, and upon which the sun seldom 
shines." I have never as yet seen a case of this or typhoid 
fever, but what I could discover in the present or previous 
location of the patient, the presence of decaying animal mat : 
ter, to account partially, at least, for the character of the disease. 

Symptoms. — The stage of incubation is generally of some days 
duration, though when the cause is intense, it may be brief. 
The patient complains of languor, indisposition to exertion, 
loss of appetite, irregularity of bowels, dryness of skin, and 
more or less pain in head or back, and soreness of muscular 
tissue. These symptoms increasing, at last a tolerably well 
marked chill comes on, the patient feels cold, especially at the 
extremities, and chilly sensations pass over the body. These 
are shortly alternated with flushes of heat, which become 
more and more marked, until febrile reaction is established. 
In rare cases, the cold stage is as well marked as in an intermit- 
tent, amounting to a rigor; in many the patient hardly noti- 
ces the cold stage, it is so slight. 

With the development of reaction, the skin becomes hot and 
dry, the urinary secretion scanty, high colored, and does not 
deposit a sediment, and the bowels are constipated. The mouth 
is dry, and the tongue coated with a slightly yellowish-white 
coat, or in some cases a heavy yellowish coat on base, with a bad 
taste in the mouth and slight nausea; in others, the gastric 
mucous membrane being irritable, it is elongated, the tip and 
edges reddened, but coated white in the center ; there is thirst, 
but not so intense as in the preceding form of fever. The 
pulse is frequent, full, sometimes hard, especially if there is irri- 
tation of the mucous membranes, or cerebro-spinal centers, but 



Synochoid Fever. 37 

rarely bounding. In some cases there is nausea and even vom- 
iting ; but if so, the tongue will either be found heavily coated 
at base, with a disagreeable taste in the mouth, and sense of 
oppression in the epigastrium, or pointed, with reddened tip 
and edges, and tenderness on pressure over the stomach. 

The condition of the nervous system is variable : sometimes 
the patient is restless, uneasy, and watchful, the special senses 
being painfully acute, so that the patient can not bear a bright 
light, and is disturbed by the slightest noise ; at others, he lies 
torpid, does not appear to appreciate his condition, is but 
slightly affected with what transpires around him, and lays 
quiet in one position. In either case there may be headache ; 
in the first it is acute, the face being flushed, and eyes red- 
dened, evidencing determination of blood; in the last it is 
generally dull, a disagreeable sensation of heaviness and 
oppression. 

The symptoms above named, increase in intensity to the third 
or fourth day, after which the fever exhibits but little change 
if uncomplicated, except the increasing debility, until after the 
seventh day ; when if it does not terminate by the establishment 
of secretion, either naturally, or by the aid of medicine, we 
observe symptoms of deterioration of the blood, and prostra- 
tion, making their appearance, and after a variable length of 
time a low typhoid condition ensues, and we have in fact to 
treat a fever of the next variety. 

Complications. — This form of fever is frequently compli- 
cated with local disease, most generally of an inflammatory 
character ; yet as the fever is fully developed before the local 
disease commences, the symptoms of the latter are often very 
obscure. 

With Predominant Affection of the Cerebro-Spinal Cen- 
ters. — This forms the nervous fever of older writers, and is not 
an uncommon disease. The symptoms are all increased in 
intensity; the skin is intensely hot and pungent, especially of 
the head and face; the pulse is rapid, strong, and full; the 
breathing frequent and suspirous, and the eyes injected and 
suffused. There is great irritability and restlessness, with 
more or less intense headache ; giddiness ; intolerance to light 
and noise, and greatly increased general sensibility. Within 
three or four days, delirium makes its appearance, followed in 
a longer or shorter time by coma-vigil, coma and insensibility, 
and by subsultus tendinum. In some cases, the cerebral affec- 



38 The Eclectic Practice of Medicine. 

tion being intense, we find stupor making its appearance 
speedily, accompanied by a slow, oppressed, and intermittent 
pulse. If the affection of the nervous centers is acute, the 
disease may terminate fatally without much disorganization of 
the blood, but if not, the fever rapidly assumes a typhoid 
character. 

With Predominant Affection of the Eespiratory Appar- 
atus. — This is the most common complication of continued 
fever, though generally, it exists in but a slight degree. The 
bronchial mucous membrane is frequently irritated, with slight 
implication of the lungs. This necessarily aggravates the 
fever, and induces farther complication, by preventing proper 
oxygenation of the blood. The patient complains of slight 
oppression and difficulty of breathing, with accelerated respi- 
ration, and slight cough. If bronchitis is fully developed the 
difficulty of breathing is increased, and secretion is generally 
established early, and a mucous ronchus is heard over , the 
chest, upon auscultation. If much of the structure of the lung 
becomes diseased, the breathing is hurried, oppressed, and 
sometimes laborious, the sputa rounded and streaked with 
blood, and in a short time exhibits the characteristic rusty 
color of pneumonia. There are manifest symptoms of imper- 
fect aeration of the blood, dark dusky hue of the lips and 
tongue, flushed appearance of face, oppressed circulation, and 
coldness of the extremities. "With such complication, we 
notice that prostration is very rapid, and contamination of the 
fluids speedily ensues, with typhoid symptoms. Low delirium 
and coma are frequent attendants upon this condition. 

With Predominant Affection of the Gastro-Enteric 
Mucous Membranes. — In some cases we observe at ;the com- 
mencement, marked symptoms of disorder of the stomach ; 
the "tongue is heavily coated, especially at its base, with a 
dirty-yellowish secretion; there is slight nausea; disgust for 
food, and oppression in the epigastrium ; every thing that is 
administered, is taken by the patient with difficulty, and fre- 
quently ejected. This condition is not generally accompanied 
with as high febrile reaction as in the uncomplicated fever, but 
there is rapid prostration, and manifestation of typhoid symp- 
toms. In this case there is increased secretion of mucous from 
the mucous membrane of the stomach, which if allowed to remain 
will undergo decomposition, and being slowly absorbed will 
generate decomposition of the blood. In other cases there is 



Synochoid Fever. 39 

marked irritation of the stomach, manifested by redness of the 
tip and edges of the tongue, uneasiness in, and pain on press- 
ure over the epigastrium, with nausea, and rejection of fluids 
and solids taken into the stomach. In this case, all the febrile 
symptoms are increased. The enteric affection does not gen- 
erally manifest itself in the early stage of the disease. It com- 
mences with looseness of the bowels, two, three, or four evac- 
uations in the twenty-four hours, with pain and soreness in 
the abdomen, "especially on pressure. The tongue is moist and 
loaded with a dirty- white, or grayish fur, which as the fever 
advances, changes to brown, and sordes appear on the teeth 
and lips ; in some cases, the edges and tip of the tongue are 
reddened. In this case, the fever rapidly assumes a typhoid 
character. 

Post-Mortem Examination. — As before remarked, this fever 
if uncomplicated, rarely terminates fatally, unless it runs into 
the next form, when the scalpel will reveal the same lesions. 
If complicated, ^there will be marked evidence of the local 
affection, though we find that the inflammation has been of an 
ataxic character. 

Diagnosis. — The character of the fever can be readily deter- 
mined after the second day ; its uniform progress, medium 
grade of reaction, and tendency to vitiation of the fluids, are 
very apparent. It is difficult in many cases to diagnose the 
local lesions; when the fever is complicated, much care must 
be used in the examination, and the symptoms carefully com- 
pared with those generally ascribed to the local affection. 

Prognosis. — The prognosis should be favorable if the fever 
is uncomplicated. If local disease should arise in its progress, 
the prognosis would depend upon its intensity, and the part 
affected. 

Treatment. — I believe that this fever can be arrested, in a 
majority of cases, at any period of its course, previous to the 
development of low typhoid symptoms, and in this I differ from 
a majority of the profession : I might have said I know it, for 
such has been the result in my practice too frequently for il 
to have been accidental. In giving the treatment, I will here 
only give the abortive plan, and refer the reader to the next 
form of fever for other treatment, for if not stopped, there is 
nothing more certain than that it will assume that form. 

There are three principal and well defined indications for 
the arrest of this disease, and if by medicinal means they 



40 The Eclectic Practice of Medicine. 

can be accomplished, the fever will be arrested. First, to pro- 
duce arterial sedation, and its attendant relaxation, and a dim- 
inution of the heat of the body. Second, to establish excretion, 
and eliminate the broken down elements circulating in the 
blood. And third, to restore the tone and integrity of the 
nervous system. 

To accomplish the first, we have the direct and indirect se- 
datives. I prefer the direct sedatives, but might here remark 
that unless properly used, they are frequently inefficient, and 
sometimes even harmful. The influence desired is gradual 
but permanent sedation, without prostration, and I hold that 
this can only be obtained in a majority of cases by small doses 
frequently repeated, giving sufficient time for the accomplish- 
ment of the result, say from one to three or four days, accord- 
ing to the condition of the patient. In my practice, I use the 
Tinctures of Veratrum and Aconite, largely diluted with Water, 
giving from one to two drops of the first, and half the quantity 
of the second, every half hour, with the frequent use of the 
sponge bath. The influence is very gradual, but it is perma- 
nent, and as sedation increases, hour by hour, I find increased 
strength of pulse, a greater equality in the circulation, and bet- 
ter innervation. JSTow, I have seen the Tincture of Veratrum 
employed, say in doses of five or six drops every three or four 
hours, and increased every second or third dose, until ten or 
fifteen drops would be taken at a time, and but little diluted, 
and the result would be temporary sedation from one to two 
hours, then reaction; and thus owing to the manner of ad- 
ministration, there would be a succession of sedation and 
excitement, until finally, perhaps, the dose would be so large 
that speedy sedation would result, with prostration ; the rem- 
edy would have to be suspended, and before it was again 
commenced febrile reaction was as high as ever. Now, we 
certainly would expect no beneficial results from such practice. 
Again, it will not do to produce sedation too rapidly by the 
administration of large doses, for very frequently a feeble cir- 
culation, with partial stasis of the blood in parts far from the 
centre of circulation would be the result, which would cer- 
tainly be as bad in many cases as the febrile reaction. An- 
other very common mistake, is the attempt to accomplish too 
much at once; thus many times the physician administers 
remedies to produce sedation, and establish secretion, and not 
satisfied even with this, administers Quinia and stimulants. 



Synochoid Fever. 41 

Kow, it must be apparent to all 'that secretion can not be 
established when there is high febrile reaction, neither can 
the nervous system be favorably impressed with Quinia; but 
these very means, by exciting certain organs, frequently pre- 
vent the due action of the sedative. 

That sedation and relaxation can be effected and continued 
by the employment of the special sedatives, few at the pres- 
ent day will deny. And if this is accomplished secretion is 
readily established. Thus, sedation being produced, we still 
continue the remedies to prevent reaction, and commence the 
employment of diaphoretics and diuretics. The mild dia- 
phoretics named in the preceding form of fever are the ones 
best adapted to secure secretion from the skin, the alkaline 
diuretics being employed to increase elimination from the 
kidneys. If from the symptoms we judge that there is accu- 
mulation of fseces in the intestines, producing irritation, we 
administer a mild cathartic, not otherwise. Secretion from 
the skin is greatly promoted by the use of the hot Mustard 
foot-bath, and warm applications to the body. 

As soon as the skin and kidneys commence to act, it is ne- 
cessary to stimulate the nervous system, so that these critical 
evacuations may not fail for want of innervation. For this 
purpose I employ Quinia, generally associated with Hydrastine. 
The medium dose of the first would be about two grains, of 
the second one grain, eveiy three hours, but we must be gov- 
erned entirely by the condition of the patient ; in these cases 
the rule that governs me in its administration is this, that as 
much should be given as the patient can take without causing 
excitation, but as soon as an increased frequency of the pulse 
is noticed its administration should be stopped, and when again 
given, it should be in smaller doses. If the patient has 
passed several sleepless nights, we will now find that he will 
be greatly benefited by a sufficient dose of Opium to induce 
sound sleep. 

If there is irritation of the cerebrospinal centers, with de- 
termination of blood, active counter-irritation to the spine and 
extremities should be immediately resorted to and continued. 
If nothing contra-indicates, a brisk but not irritating cathar- 
tic may also be administered as a means of derivation. The 
Tincture of Gelseminum, in connection with the sedative, be- 
comes then a valuable remedy, whilst the heat of the head 
may be removed by the application of warm water, and its 



42 The Eclectic Practice of Medicine. 

evaporation by fanning. If, as in some cases, there is de- 
rangement of the stomach, with morbid accumulations, no- 
thing will give as speedy relief, as a thorough emetic. 

If bronchitis or pneumonia should arise, judicious counter- 
irritation should be employed, with warm stimulant foment- 
ations to the chest, and *nauseant expectorants to promote 
secretion. This, however, should not interfere with the 
proper treatment of the fever. If the lungs become much 
engorged, with great difficulty of breathing, an emetic of the 
Acetous Emetic Tincture, or Compound Powder of Lobelia 
and Capsicum, should be immediately administered and carried 
to thorough emesis and relaxation, and followed by warm 
diaphoretics and other adjuvant means to promote secretion 
from the skin. 

In those cases in which the tongue is heavily loaded, with 
nausea and oppression at the epigastrium, all treatment must 
be preceded by a thorough emetic. In this condition, no 
remedies will produce a favorable influence, until the morbid 
accumulations in the stomach are removed, and if not done, 
the prostration will be rapid and typhoid symptoms speedily 
manifested. If there is irritation of the stomach, this must 
be first subdued. Counter-irritation to the epigastrium and 
extremities, with the' employment of those agents known to 
relieve gastric irritation, should be used here. Frequently 
the employment of stimulant enemata, by stimulating to 
action the lower intestine, and producing free evacuation, will 
greatly aid the other measures. The enteric disease should 
be controlled, as named under typhoid fever. 



TYPHOID FEVEP. 

It will be recollected that any fever, either idiopathic or 
symptomatic, will assume a typhoid character, if it continues 
sufficiently long for the blood to become engaged in a process 
of decomposition. Now, in all such diseases, we notice that 
there is more or less rapid breaking down of the tissues, and 
the excretory organs being in such condition' that it can not 
be freely removed, the detritus of the body remains in the 
blood. This material is undergoing retrograde metamoiyhosis, 
and it is a well ascertained fact, that in certain conditions of 
the system, this decomposition is propagated in the blood. If 



Typhoid Fever. 43 

these be facts, we can readily see how a patient may be pois- 
oned by the breaking down and retention of his own tissues. 
Thus says Dr. Williams, " In several cases of the early stage 
of the severest form of Bright' s disease, in which the urine 
was very scantily secreted and highly albuminous, I have seen 
typhoid symptoms of the worst character ensue, accompanied 
by a breaking up and partial solution of the coloring matter 
of the blood, with the appearance of pus globules in it." 

There are causes producing fever which affect the integrity 
of the blood at the beginning, setting up within it a process 
of decomposition, which is more or less rapid, according to 
the degree of vital power in the system. Such causes would 
produce typhoid fever, and if the vital power of the patient 
was depressed at the time of exposure, the symptoms would 
be evident from the commencement. 

Causes. — The predisposing causes of typhoid fever, are all 
such as greatly depress the vital power of the system, either 
temporarily or permanently, and we might say, with truth, 
that no person unless originally of feeble vitality, or laboring 
under some cause that produces depression at the time of ex- 
posure, can have primary typhoid fever. It is true, that if 
the cause acting upon the system was very intense, the disease 
might be rapidly developed. Animal miasmata is the excit- 
ing cause of the disease, and by this we understand animal 
matter in a state of decomposition. Liebig says, "An animal 
substance in the act of decomposition, or a substance gener- 
ated from the component parts of a living body by disease, 
communicates its own condition to all parts of the system 
capable of entering into the same state, if no cause exist in 
these parts by which the change is counteracted or destroyed." 
Thus, exposure to gaseous exhalations from animal matter un- 
dergoing decomposition, or arising from persons suffering 
from low typhoid disease, the material gaining entrance into 
the blood through the lungs, will, if there is not sufficient 
resistance in the system, set up a process of decomposition, 
which continuing, will give rise to the phenomena we 
observe in this form of fever. Thus, in those cases in which 
decomposing animal matter is introduced into the system by 
a dissecting wound, we observe, first a chill, then febrile reac- 
tion with great depression, and finally, evidence of complete 
death of the blood, all the symptoms of reaction being of a 
typhoid character. 

This form of fever may be either endemic, sporadic, epi- 



44 The Eclectic Practice of Medicine. 

demic, or contagious; if endemic, we will find a more or less 
intense local canse ; if sporadic, the miasm may have been 
speedily generated and dispersed ; if epidemic, we have to 
look to the condition of the atmosphere, as regards moisture 
and temperature, for the rapid propagation and spread of the 
.miasm. That in certain conditions the disease is contagious, 
I believe few will deny. Thus, from a person suffering from 
low typhoid fever, there is continually given off in the excre- 
tions, and from the lungs, matter in a state of decomposition, 
and if proper attention is not paid to ventilation and cleanli- 
ness, these exhalations assume a degree of intensity that will 
unfavorably impress all that come within their reach, and 
will give rise to the same form of fever, in those predisposed 
to disease. 

Symptoms. — The stage of incubation is frequently of con- 
siderable duration in this disease, the symptoms being those 
of depression. The patient complains of languor and debility, 
with giddiness, dullness, and confusion of intellect ; the appe- 
tite is impaired, uneasiness at the epigastrium, and sometimes 
slight nausea ; a general sense of soreness and stiffness, with 
more or less pain in the back and limbs is not unfrequent. 
These symptoms increasing for two or three days, the patient 
complains of slight chilly sensations, with coldness of extremi- 
ties, which becoming more marked, are alternated with flushes 
of heat, This chill lasts from six to eight hours, but some- 
times is prolonged to one or two clays. 

With the development of reaction, the pulse becomes fre- 
quent, fall and open, or soft and weak, in some cases soft and 
easily compressed, or if of a nervous character, quick and 
sharp. The tongue is generally loaded with a dirty mucus, 
and is broad, soft, flabby and moist, but sometimes coated in 
the center, but with reddened tip and edges; there is consid- 
erable thirst. In some cases the tongue is heavily loaded, 
especially at the base, with bad taste in the mouth, and feel- 
ing of oppression at the epigastrium, indicating morbid accu- 
mulations in the stomach. The urine is slightly diminished 
in quantity, appears turbid and frothy, but does not deposit a 
sediment ; the bowels are frequently natural as to frequency, 
but extremely susceptible to the action of medicine ; the dis- 
charges being thin, pale, and frothy. The temperature of the 
surface varies greatly, sometimes it is intensely hot and pun- 
gent, but more frequently, but slightly increased, with tendenc}" 
to coldness of the extremities. The countenance is dull, pallid, 



Typhoid Fever. 45 

and shrunk, or transiently flushed; the eyes heavy and devoid 
of lustre, and the head heavy, confused, and giddy. The patient 
sometimes exhibits great uneasiness, and is restless, changing 
his position frequently, but at others is torpid, careless, and 
unimpressible. The respiration is frequently but little affected 
the first two or three days, but sometimes frequent and 
suspirous. 

By the fifth to the eighth day we find that the head has 
become more affected, and the mind is confused, the patient 
reasons with difficulty and answers slowly. Sometimes, even 
at this early period, we have a partial development of that 
dreamy delirium termed typhomania. The respiration has 
now become affected, and is short and quick, or labored and 
suspirous. In many cases symptoms of enteric affection 
begins to manifest itself; the bowels are irregular, two, three, 
or four evacuations in the twenty- four hours, watery, yellow- 
ish, clay-colored, frothy, and foetid. The urine is but lit- 
tle diminished in quantity, but is pale and frothy, resem- 
bling whey or new made beer. The patient in many cases, 
now begins to complain of tenderness of the bowels, and it 
will be found that pressure produces pain. 

By the tenth or twelfth day, the bowels have become quite 
loose, the operations frequent and difficult to arrest, with 
increased tenderness on pressure, and flatulent distension of 
the abdomen. The coating of the tongue has been gradually 
changing its color, and is now coated brown, somewhat fis- 
sured, or sometimes the coating has disappeared and the tongue 
is dry, red, and glossy ; sordes commence to appear upon the 
teeth and lips. Typhomania has now become fully devetoped, 
the patient appears half-asleep, his mind wanders, he talks to 
himself of his business, his pleasures, or reveling in the cham- 
bers of memory he appears to be living his past life over. 
Sometimes this typhomania is replaced by coma-vigil, the pati- 
ent appears to be in a profound stupor, but is aroused by the 
slightest sound, to immediately sink back into his former con- 
dition. About this time, though sometimes as early as the 
fifth day, the rose-colored eruption makes its appearance upon 
the breast and neck; this eruption manifests itself in small 
rose-colored spots about the size of the head of a pin, the 
color disappears upon pressing the finger over them, but 
returns when the pressure is removed. Milaria sometimes 
makes its appearance at this time, in the shape of minute 
vesicles, filled with limpid serum. The patient has now be- 



46 The Eclectic Practice of Medicine. 

come so prostrated that he requires assistance to get up in bed, 
or change his position. 

From this to the twentieth day, the diarrhoea becomes worse, 
the discharges being dark, foetid, and very offensive, and the 
abdomen very much distended ; the coating upon the tongue 
becomes almost black, and the teeth and lips covered with a 
dark offensive sordes. The prostration is extreme, and the stu- 
por profound. Frequently the heat of the surface sinks, the 
extremities being kept warm with the greatest difficulty ; and 
sometimes there is foetid perspiration. Petechia sometimes 
make their appearance in the shape of small purplish-red dis- 
colorations, not effaced by pressure ; these extending, form 
vibices. The posture is constantly supine, with tendency to 
slip down to the foot of the bed. The faeces and urine are now 
discharged involuntarily, or in some cases there is suppression 
of urine, which, if allowed to continue, will cause great dis- 
tension of the bladder with rapid prostration and death. Sub- 
sultus tendinum comes on, with picking at the bed-clothes, 
and finally jactitation. At last, the vitality of the patient 
is so far exhausted, that there is no longer power to circulate 
the blood, and the patient dies. 

Complications. — This form of fever is not unfrequently com- 
plicated by low forms of inflammation of various organs, and 
as the symptoms are obscure in many cases, much care must 
be used in the diagnosis. The principal complications, are 
those named in the preceding form of fever, and, as the 
symptoms are the same, with the exception that they are of 
a lower grade, the reader is referred to that for description. 

Post-Mortem Examination. — Dissection shows the blood 
dark, fluid, diffluent, and the red globules partly broken down, 
with, sometimes, the presence of gas in the vessels. Frequently 
there has been transudation of blood from the vessels into 
some of the tissues, giving rise to dark discoloration, and 
ecchymoid spots. All the soft tissues are softened, but this is 
especially marked in the mucous membranes. In about eighty 
per cent of cases, Peyer's glands will be found diseased ; some- 
times there is mere engorgement, owing to the deposit under 
the mucous coat of a yellowish- white matter ; in the majority 
of cases there is ulceration, and sometimes the ulceration has 
extended in width and depth, affecting the sub-mucous, mus- 
cular, or even serous coats, occasionally ending in perforation. 
The mesenteric glands are very generally enlarged and soft- 



Typhoid Fever. 47 

tened, sometimes containing puriform matter. The other vis- 
cera of the abdomen occasionally suffer, but this is generally 
the result of a low form of inflammation, during the progress 
of the disease. 

The lungs are often much diseased, even when not affected 
by inflammation, but this is referable to the predominance of 
the physical over the vital forces in the last days of the ill- 
ness, they being congested and much softened, especially in 
their most dependent portions. Great prostration of the ner- 
vous system was a prominent symptom from the commence- 
ment, but we do not find sufficient lesion of the cerebro-spinal 
centers to account for it. Thus, in thirty-eight cases, exam- 
ined by Chomel, there was injection of the membranes in four, 
oedema of the membranes in seven, slight softening of the brain 
in six, effusion of serum in ventricles in twelve, red points in 
nervous matter in five, increased density in two, but in fifteen 
there was no perceptible lesion. 

Diagnosis. — In the first stage, the peculiar dullness of intel- 
lect, prostration of strength, and feeble pulse, is sufficent to 
determine the character of the disease. Then, the lax condi- 
tion of the bowels, tenderness on pressure, typhomania, rose- 
colored eruption, dark coating of the tongue, sordes on teeth, 
etc., that gradually make their appearance, are so evident, that 
no mistakes can occur. 

Prognosis. — In the early stage, if there is no complication, 
the prognosis is favorable, as in a majority of cases the dis- 
ease can be arrested before the severer symptoms make their 
appearance. If complication should arise, the case becomes 
more grave, and the prognosis will have to be guarded. In 
the latter stages of the fever, if the nervous depression 
becomes less, with tendency to quiet sleep, brighter color of 
rose-colored eruption and petechia, turbid urine, natural stools, 
and soft, warm, and moist skin, the prognosis is favorable. 
But, if coma increases, with subsultus tendinum, hemorrhage, 
involuntary discharges of fasces and urine, feeble and intermit- 
tent pulse, cold extremities, foetid perspiration, etc., the patient 
will probably die. 

Treatment. — The object of treatment at first, is the arrest 
of the fever, and this can be accomplished, in a majority of 
cases, by the seventh day, and before the severer symptoms 
make their appearance. The abortive treatment is the same 
as in the preceding disease, but I will repeat it. 

First, if there is evidence of morbid accumulation, in the 



48 The Eclectic Practice of Medicine. 

stomach, this must be removed, or all treatment will prove 
unsuccessful. I know from personal observation, that where 
the stomach is thus oppressed, typhoid symptoms rapidly super- 
vene, and the probabilities are that the patient will die ; and 
farther, that such accumulation in the stomach, proves the cause 
of the rapid development of the enteric disease in many cases. 
In this case, an emetic precedes all other treatment, the Ace- 
tous Emetic Tincture, or Compound Powder of Lobelia and 
Capsicum being my favorite agents ; if there is great prostra- 
tion, a stimulant should be combined with them. The action of 
the emetic should be prompt and thorough, and aided by warm 
stimulant diaphoretic infusions, which should be continued 
afterward to produce diaphoresis, aided by the hot mustard 
foot-bath, and warmth applied to the body. As soon as the 
emetic has ceased acting, the special sedatives should be admin- 
istered in doses just sufficient to continue the influence pro- 
duced by it. If in the early part of the disease, the bronchial 
mucous membrane or lungs become affected, the same treat- 
ment should be adopted, with the addition of counter-irri- 
tation. 

In other cases we commence the use of the direct sedatives, 
and here I prefer the Veratrum, associated with Asclepias, 
as #. Tincture Veratrum Vir., f3ss., Essential Tincture of 
Asclepias, f3j., Syrup of Lemon, f3ij. — M., and administer a 
teaspoonful every hour. If the skin is hot and pungent, the 
alkaline sponge bath should be employed, three or four times 
a day, but if there is deficient capillary circulation, with ten- 
dency to coldness of the extremities, a sufficient quantity of 
Tincture of Capsicum, added to water, to give the necessary 
stimulation, should be employed in its stead. The extrem- 
ities must be kept warm, or the entire treatment will fail, be- 
cauuse, if they are cold, with deficient capillary circulation in 
the skin, there is stasis of blood in internal organs, which suf- 
fer as well as the blood, and if sedatives are now adminis- 
tered, these conditions are increased, and though the pulse is 
diminished in frequency, it is also decreased in strength, with 
still farther congestion. Sometimes I find it necessary to order 
the frequent application of Tincture of Capsicum, or other 
strong stimulant, to the extremeties, with the constant use of 
bottles of hot water, etc. 

The dose of Veratrum named, is about the medium quantity, 
where there is evidence of congestion it will have to be smaller, 
if the febrile reaction is vigorous, it may be increased. I do 



Typhoid Fever. 49 

not desire marked sedation under twenty-four hours, and many 
times not before forty-eight, or seventy-two hours. We will 
notice, that the above remedies, used in this way, gradually 
decrease the frequency of the pulse, but it becomes more full, 
stronger, and especially better in parts far from the heart, with 
better innervation. At last, the pulse coming down to eighty 
or ninety beats per minute, we observe evidence of commenc- 
ing secretion. Now, diaphoretics and diuretics may be 
advantageously employed, the sedatives being continued in 
doses just sufficient to maintain its effect. The preparation of 
Asclepias, above mentioned, I use, first, for its gentle stimulant 
and soothing influence, upon the nervous system, and because 
it tends to stimulate circulation to the surface, but now it may 
be continued as a diaphoretic, or other gently stimulant agents 
used in its' place. As a diuretic, I employ a weak solution of 
equal parts of Chlorate and Acetate of Potassa, the medium dose 
of each being about five grains every four hours. 

When secretion has commenced, but not before, we resort to 
Quinia to increase innervation; I generally employ it in the 
following combination, #. Quinia Sulphas, Hydrastin, aa. 3ss. 
— M., and divide into fifteen powders, the dose being one every 
three hours, being governed as we mentioned in the preceding 
disease. If it seems necessary, stimulants may be employed 
in addition. 

Then, if the patient shows no tendency to sleep, about nine 
or ten o'clock in the evening, when everything has become 
quiet, a sufficient dose of opium should be given to induce 
sleep. 

During this time, the patient should be freely supplied with 
diluents, and such light food as the appetite craves, and we 
think can be easily digested. Everything in the room and 
about the patient should be kept scrupulously clean, and the 
apartment thoroughly ventilated by admitting air from the 
sunny side of the house, and keeping an open fire in the room. 
Few persons should be in the room at a time, and the patient's 
mind kept calm ; especially should care be used not to excite 
expectant attention in the patient by secret movements, whis- 
pered conversation, or by failure of attention at the time 
expected. More depends upon this, than is generally admitted 
bv physicians. We can not "kick nature out of doors, and 
depend upon the materia medica," as has been advised by a 
somewhat prominent physician. 
4 



50 The Eclectic Practice of Medicine. 

When the disease has progressed for some days, and the 
"blood becomes seriously affected, we may not be able to arrest 
it, at least, not speedily, and we must adopt additional treat- 
ment to meet the development of low typhoid conditions. 

"When tenderness of the bowels is first noticed, the use of 
dry cups, followed by the application of Tincture of Arnica, and 
Turpentine, to the abdomen, will be found beneficial. Some- 
times, warm stimulant fomentations produce a good effect. If, 
at this time, there is torpor of the bowels, with indications that 
retained faeces are producing irritation, a nild cathartic, care- 
fully administered, will be advantageous, under no other cir- 
cumstances should cathartics be employed. The diarrhoea may 
be controlled at first, by the employment of any of the mild 
astringents, frequently the Tris-nitrate of Bismuth in solution 
with Peppermint-water and Turpentine, acts admirably in doses 
of three grains of the first, one or two drachms of the second, 
and ten to twenty drops of the third. An infusion of the bark 
of the young limbs of the Peach tree, in teaspoonful doses, with 
a small quantity of Tincture of Xanthoxylum, and one or two 
grains of Geranin is one of the best means of arresting it. 
Tymphanitis is relieved by the local application of Turpentine, 
demulent enemas containing the same, and its internal admin- 
istration with Tincture of Xanthoxylum. Dr. Stoker, strongly 
recommends enemata of Yeast and Assafcetida, as the most 
efficacious means of removing this condition. 

The prostration of the nervous system is combated with 
Quinia, bitter tonics, stimulants, and the regular administra- 
tion of small quantities of nourishment, as beef-tea, etc. When 
manifested by typhomania or coma vigil, the Ammoniated 
Tincture of Valerian, with Camphor, Tincture of Cypripedium or 
Serpentaria, maybe used with advantage. If there was immi- 
nent danger to the patient, and especially if the discharges 
from the bowels were copious, I would administer Opium, with 
Camphor and warm aromatic spices, the dose of the first being 
large enough to induce sleep, say from one to two grains. 

To control the septic condition of the blood, acid drinks 
should be freely given, when desired by the patient. The 
Chlorate of Potash, combined with Hydrochlorate of Ammonia, 
is often useful. When the diarrhoea is profuse, the Chlori- 
nated Soda or Labarraque's solution, is probably the best of the 
chlorides; its administration should be commenced in doses of 
fifteen drops, in aromatic water, every three or four hours, 



Typhoid Fever. 51 

increasing it as the disease progresses, to thirty or forty drops. 
Yeast has been employed with advantage in doses of two table- 
spoonfuls every three hours, with an equal quantity of Cam- 
phor mixture. It is said by Dr. Stoker, " to correct the morbid 
contents of the alimentary canal, and the consequent symptoms 
of putrescence, petechia, and black tongue, being more effectu- 
ally removed by it than by any other means." 

With the exception of Quinia, I doubt much, whether any 
advantages result from the administration of the bitter tonics. 
Stimulants additional to those named are required in the 
advanced stage of the disease, but they must be administered 
with care; small quantities, frequently repeated, so as to keep 
up a continued influence, are beneficial, but under no circum- 
stances, should the system be over-stimulated by large doses, 
and the stimulant then stopped, for the prostration ensuing 
might be fatal. Small quantities of bland nutricious food 
should be regularly administered, and bland mucilaginous or 
acid diluents sufficient to satisfy the patient's thirst. 

The patient's position should be frequently changed, and the 
bed shook up beneath him, and the cover straightened out. 
This is necessary to prevent injurious pressure on any part, 
which might give rise to bed sores ; if any part becomes tender, 
with dark discoloration, or blanched white appearance, dilute 
Tincture of Arnica and means to remove the pressure from 
the part should be employed. If bed-sores form, they should 
be washed with a solution of Sulphate of Zinc, from gr. x., 
to gr. xx., to the ounce of water, and a dressing of mild 
Zinc ointment applied, the pressure being removed; this is 
generally sufficient for a cure. 

If the disease exhibits a tendency to yield during the latter 
period of its progress, excretion should be aided by mild dia- 
phoretics and diuretics, though under no circumstances, must 
an additional amount of heat be applied to hurry their action. 
As soon as secretion commences, Quinia may be given in 
increased doses with advantage. Convalescence must be man- 
aged with great care, when the patient has been thus pros- 
trated. Nourishing food of easy digestion, taken in small 
quantities, with gentle stimulants and tonics, pure air, light, 
and sunshine, are required. As convalescence becomes estab- 
lished, animal broths, with easily digested solid food, may be 
taken, but strictly prescribed by the physician, as to kind, 
quantity, and frequency. 



52 The Eclectic Practice of Medicine. 

TYPHUS FEVER. 

This form of fever is undoubtedly different from any of the 
preceding, as it is determinate in its course, and presents a 
regular succession of all the febrile changes, among the most 
prominent of which is the appearance of a characteristic cu- 
taneous eruption. Though there is, from the beginning, a 
marked tendency to sepsis of the blood, yet the fever may 
pass through all its stages without that manifest putrescency 
noticed in the latter stages of typhoid fever; this, however, 
is rare. 

Causes. — The exciting cause of true typhus is undoubtedly 
an animal miasm, generated by the congregation of a number 
of persons in close apartments, without regard to cleanliness, 
as in jails, hospitals, ships, and the crowded and ill -ventilated 
quarters of large cities; or by the disease itself, the emana- 
tions from patients suffering from it, being capable of propa- 
gating it to others. The miasm contaminates the air, and 
infects the healthy frame through the respiratory organs, 
either directly as it proceeds from the morbid source, or 
indirectly by means of substances capable of retaining it for 
a time and of giving it out upon exposure to air. The pre- 
disposing causes are all those that weaken and debilitate the 
system, even if this debility is but temporary. Thus, as above 
remarked, the emanations from a patient suffering from the 
disease being capable of propagating it, no person should visit 
such patients, or remain long with them, if suffering from but 
temporary prostration. The disease is not only contagious, 
but it is said that a " regular and fully developed attack seems 
to prevent a second, for many years afterward, if not forever. " 
The stage of incubation, or time from exposure to the cause 
and the full development of the fever, is usually from three 
to seven days, or even, sometimes, two or three weeks; but 
occasionally the cause being very intense, the attack may take 
place immediately on exposure. 

Symptoms. — The symptoms of the forming stage are similar 
to those in other forms of fever, indicating gradual arrest of 
function and nervous prostration. The invasion of the disease 
is marked by creeping sensations on the trunk and back, fol- 
lowed by shiverings, paleness of the surface, cutis anserina, 
heaviness and giddiness of the head, and more or less pain in 
the back and limbs; frequently there is considerable thirst. 
In a short time, these cold sensations are alternated with 



Typhus Fever. 53 

flushes of heat, which increase until reaction is permanently 
developed. 

With the full development of reaction, the pulse becomes 
full and strong, though sometimes exhibiting evidences of 
oppression from the commencement ; the countenance is 
flushed, the head confused, heavy or giddy, and the skin hot 
and turgid. The urine is scanty and high-colored, the bowels 
constipated, with frequently nausea and vomiting. After a 
restless night, we find that the heat of the skin has increased ; 
there is still farther arrest of the secretions, but the nausea 
and vomiting have ceased. The weight of the head changes 
to stupor, with frequently tinnitus aurium, the giddiness has 
increased, and frequently the upright position can not be 
borne. 

By the third or fourth day a catarrhal affection, peculiar to 
this fever, is developed. The eyes become red, the mucous 
membrane of the nose, fauces and mouth are tumid and red, 
deglutition is difficult and painful, there is tightness and op- 
pression of the chest, with frequently cough; both hypochon- 
dria are tense and painful. The patient is averse to making 
the slightest exertion, is impressed with difficulty, reasons 
slowly, and is tardy in his answers ; the tongue is generally 
protruded with difficulty, and is tense and tumid, uniformly 
dark-reddened, and coated with a dusky grayish brown coat, 
or entirely free from coating, but red and glistening. 

Shortly an exacerbation occurs, which is sometimes preceded 
by epistaxis,and partial relief of the cerebral symptoms. About 
the sixth day, the surface of the body becomes turgid and of 
a somewhat clingy-red, and the eruption appears. " It is of a 
florid, reddish, or reddish-pink color, disappearing on pressure, 
but soon returning when pressure is removed. This circum- 
stance is sufficient to distinguish it from petechia. The more 
exuberant resembles the measles, and has been mistaken for 
them ; but it is more papillar, and rougher to the touch, being 
sensibly elevated to the eye; and although sometimes grouped 
or crowded, it does not coalesce so much as measles, but each 
papilla is more or less separate." On the second day, another 
exacerbation occurs, followed by a slight remission of a few 
hours duration, when the nervous stage of the disease is 
introduced. 

The turgidity of the skin disappears, but the surface is still 
dingy-red, and the heat increased ; the skin is dry, shriveled, 



54 The Eclectic Practice of Medicine. 

and the epidermis brittle ; petechia, or slight extravasations 
of blood under the cuticle, and frequently miliaria, make their 
appearance. The catarrhal symptoms all disappear, the breath- 
ing is free, but frequent, and the cough ceases, but is succeeded 
by more or less singultus. The tongue becomes parched and 
shrunk, and, if loaded, of a dark-brown or black color, or if 
clean, is red, smooth and glistening, resembling raw beef. The 
thirst is increased, but the torpor is often so great that the 
patient does not ask for drink, but takes it eagerly when 
offered; swallowing is impeded, owing to dryness of the 
mouth. The pulse is generally full and free, and not very 
frequent, but imperfect contraction of the artery may be no- 
ticed, after the heart's impulse. The bowels now become 
disordered, with frequent, loose, foetid discharges, sometimes 
accompanied by pain in the bowels, and flatulent distension. 

With the continuance of the disease, we notice an increased 
suppression of muscular power, and an increase of involun- 
tary motion, as tremors, subsultus tendinum, and slight con- 
ulsions. There is impairment of the senses, deafness, 
defective vision, smell and taste. Typhomania makes its 
appearance, the patient dreams without being asleep, talks 
deliriously, is occupied with his internal impressions, and is 
with difficulty impressed by external objects. 

The symptoms of the crisis are thus described by Copland : 
"At the end of the thirteenth day a more serious exacerbation 
than any former one takes place; the heat is more glowing, 
the arteries pulsate more strongly, the brain is more affected, 
and the stupor passes into sopor. In twelve hours afterward, 
and on the fourteenth day, the parched skin shows a tendency 
to perspiration. In some cases slight epistaxis occurs, with 
relief to the head; the nostrils become moist; the tongue, at 
the point and edge, moist, clean and red ; and perspiration 
more copious and general. A free expectoration often takes 
place, especially if the chest has been affected. When the 
perspiration is salutary it is uniform, not clammy, has a pecu- 
liar smell, and occurs during sleep. The stools are now copious, 
loose and offensive; and the urine plentiful, muddy, high- 
colored, and deposits a copious sediment. With these changes, 
or in a few hours afterward, the patient seems as if he had 
awakened from a dream, or from a state of intoxication ; and 
with the return of complete consciousness all the severe symp. 
toms abate. A sense of fatigue and weakness, soreness of the 



Typhus Fever. 55 

whole body, pale, hollow countenance, giddiness, deafness, and 
tinnitus aurium, drowsiness, or frequent inclination to sleep* 
tendency to perspire, quick pulse, and acceleration of it upon 
slight irritation or exertion, unnatural taste in the mouth, 
whitish tongue, etc., remain for six or seven days after the 
crisis, these symptoms gradually disappearing, the tinnitus 
aurium last of all." 

If complications should arise during the progress of the 
disease, all the symptoms will be aggravated ; it is not, how- 
ever, so frequently complicated as the preceding forms of fever. 
The complications are generally of an inflammatory character, 
and the symptoms tolerably well marked. 

Post-Mortem Examination. — "Dissection shows the blood 
dark, black, and diffluent, very rarely coagulated ; sometimes, 
however, black clots are found in the larger vessels, and more 
or less softening of the heart. The disease of Peyer's glands, 
noticed in the last form of fever, is not found in this disease. 
The skin frequently presents petechia and vibices, and dark 
blotches, or even gangrenous eschars and sphacelus are met 
with upon parts continually pressed by the weight of the 
body. If any part has been aifected by inflammation, the 
attendant lesions will be noticed on examination. 

Diagnosis. — The diagnosis is not difficult, as will be seen 
from the above symptoms. The high character of the febrile 
reaction, with the stupor of the nervous system ; the catarrhal 
affection, with turgidity and dusky discoloration of the skin ; 
the exacerbations, and appearance of eruption ; and the pecu- 
liar symptoms of the nervous stage, are sufficient to determine 
the character of the disease. 

Prognosis. — This is the severest form of continued fever, 
and the prognosis will not, therefore, be as favorable as in 
others. If prompt treatment in the early stage is adopted, the 
fever may be arrested ; but if it has run for several days, med- 
icine can only aid the natural crisis at about the fourteenth 
dav. 

Treatment. — In most respects the treatment heretofore 
named for typhoid fever will be the most appropriate for this. 
In fact, in all except the treatment for the arrest of the dis- 
ease, it will be the same, and therefore does not need repetition. 
I should not be willing to say positively that the disease can 
be arrested, as my experience in its treatment has been limited; 
still, I believe that it can, as above stated. 



56 The Eclectic Practice of Medicine. 

The abortive plan, adopted in typhoid fever, may be pur- 
sued here; the administration of the special sedatives to 
reduce the frequency of the pulse, assisted by the alkaline 
sponge bath and friction; then the employment of diapho- 
retics and diuretics, followed by Quinia and Opium. Free 
evacuation of the bowels, by unirritating remedies, is indi- 
cated at the commencement. I can better illustrate the 
treatment by reporting two successful cases. 

John R., aged 13, a stout, robust boy, never was sick, and 
of healthy parentage. His grandfather, aged 58, had well 
marked typhus fever, which, from unbelief in physicians, was 
allowed to run into the nervous stage before I was called, 
having progressed eight days; he lived until the twenty-sixth 
day, marked putro-adyuamic symptoms being present for the 
last eight days, with vibices, and gangrenous eschars on parts 
suffering from continued pressure. The boy, young as he 
was, was in almost constant attendance upon the old gentle- 
man, until three days before his death. He was then attacked 
with a slight chill, lasting about two hours, febrile reaction 
came on, the heat of the trunk was intense, the face flushed 
and dark, but the extremities were cool ; the nervous S3-stem 
was entirely prostrate, the stupor being so great that no intel- 
ligible answer could be obtained to my questions. I immedi- 
ately had a kettle of water heated, and strongly saturated 
with mustard; woolen cloths were wrung out of this, and 
applied to the lower and upper extremities, bottles of hot 
water and hot bricks being used to continue the heat; a 
sinapism was applied the entire length of the spine. A 
strong infusion of the Compound Powder of Lobelia and 
Capsicum being prepared, I commenced its administration 
in doses of a teaspoonful every five minutes, giving with the 
first dose Podophyllin gr. ss., Jalap, gr. v. The emetic infu- 
sion was continued for two hours before vomiting came on, 
which was assisted by Black Pepper tea; the emesis was thor- 
ough, and attended by complete relaxation, slight perspira- 
tion, an equal circulation of the blood, and return of con- 
sciousness. The cathartic operated freely in about two hours 
afterwards. Though the severest symptoms had passed off, 
the patient was as much prostrated as he would have been by 
a week's severe illness. Quinia, gr. iij., Tannic Acid, gr. j., 
was then administered every three hoars, until three doses 
had been taken, afterward, three doses per day; an infusion 



Eruptive Fevers. 57 

of Asclepias Tuberosa was given freely, and heat continued 
to the lower extremities. The patient was able to sit up the 
fifth day. Now this might not have been typhus fever, and 
yet from the boy being so closely confined with a person suf- 
fering from undoubted typhus, it was reasonable to suppose 
that it was the same disease. 

The second case likewise originated from contagion, the 
young man having been in attendance on the same patient. 
In this case, the premonitory symptoms existed for three or 
four days, terminating in a marked chill, which was followed 
by as high febrile action as I ever witnessed, with the same 
stupor and lurid appearance of the countenance. In this case 
I directed Tinct. Veraturn Viride, in doses of three drops 
every hour in infusion of Asclepias Tuberosa, the latter to be 
taken freely, the alkaline sponge bath, and brisk counter- 
irritation to the spine. Ten hours afterwards the fever had 
not abated, the skin being intensely hot, I used the cold, wet 
sheet pack, continuing the sedative; in a short time the heat 
abated, the pulse was reduced in frequency, when Quinia 
was administered as before, the sedative being continued, and 
the patient convalesced readily. 

I am just as well satisfied, however, that if the fever con- 
tinues beyond the seventh day, the abortive plan of treatment 
will be a failure. The treatment named for the latter stages 
of typhoid fever should therefore be adopted, being governed 
entirely by the condition of the patient. 



ERUPTIVE FEVERS. 

This class of diseases is propagated by a specific contagion, 
which, gaining access to the blood, generates the same spe- 
cific virus, and is then thrown upon the surface in the form of 
an eruption. These diseases are most frequently contracted 
by the inhalation of gaseous exhalations from a patient suf- 
fering from the disease, or from the discharges, and also by 
personal contact, the morbid material being absorbed from 
the skin. The most of them may likewise be communicated 
by inoculation, or the introduction of the virus, or even the 
blood of a patient suffering from disease, under the epithe- 
lium by puncture, or from any part of the body, if there 
is an abrasion. They are not only contagious, but they 
sometimes become epidemic, which is undoubtedly occasioned 



58 The Eclectic Practice of Medicine. 

by some change in the constitution of the atmosphere, inap- 
preciable to us, but which favors the spread of the specific 
poison. These affections differ from all other forms of fever, 
in that an attack protects the individual from ever having the 
disease again, even though being exposed to the cause; to 
this there are some rare exceptions. 

Liebig thus accounts for the disease, and its protective 
influence: "When a quantity, however small, of contagious 
matter, that is, of the exciting body, is introduced into the 
blood of a healthy individual, it will be again generated in 
the blood, just as yeast is produced from wort. The condi- 
tion of transformation will be communicated to a constituent 
of the blood; and in consequence of the transformation suf- 
fered by this substance, a body identical with or similar to 
the exciting or contagious matter, will be produced from 
another constituent substance of the blood. The quantity of 
the exciting body newly produced must constantly augment, 
if its further transformation or decomposition proceeds more 
slowly than that of the compound in the blood, the decompo- 
sition of which it effects. * * * In the abstract chemical 
sense, reproduction of a contagion depends upon the presence 
of two substances, one of which becomes completely decom- 
posed, but communicates its own state of transformation to 
the second. The second substance thus thrown into a state 
of decomposition is the newly-formed contagion. * * * 
When the constituent removed from the blood is a product of 
an unnatural manner of living, or when its formation takes 
place only at a certain age, the susceptibility of contagion 
ceases on its disappearance. The effects of vaccine mat- 
ter indicate that an accidental constitution of the blood is 
destroyed by a peculiar process of decomposition, which does 
not affect the other constituents of the circulating fluid." 

It will not be necessary to refer again to the causes of these 
eruptive fevers. It might be remarked, however, that some 
persons are exempt from this influence through life; others 
may be exempt from it at certain times, and thus be exposed 
several times and not be affected by the contagion, but after- 
wards upon exposure the disease will be contracted. 

In some cases the influence of the contagion does not cease 
with the formation of the specific virus, but originates a sep- 
tic decomposition of the blood, giving rise to putro-adynamic 
symptoms, which frequently result in death, sometimes even 
before the appearance of the characteristic eruption. 



Variola. 59 



VARIOLA. 

SMALL POX. 

Symptoms. — The symptoms depend much upon the constitu- 
tion of the patient, the intensity of the cause, and the state of 
the atmosphere, whether epidemic or not. The disease has 
been divided into several varieties by authors, according to its 
intensity; we need notice but two: the discrete and confluent; 
the first mild, the points of eruption being distinct and separ- 
ate, the second severe, the eruption being profuse, and so 
closely situate as to run into one another. In describing the 
course of the disease, the symptoms of the discrete will be 
first named, and followed by the confluent. We divide the 
disease into three stages : 1st, of incubation ; 2d, of maturation ; 
and 3d, of decline. 

Stage of Incubation. — This comprises the period from 
exposure to the cause, to the development of the chill, and may 
be from seven to sixteen days, usually about twelve days when 
the disease is contracted in the natural way. At the time of 
exposure the patient may feel unpleasantly impressed by the 
morbid poison, yet frequently no notice is taken of it. Gen- 
erally about the sixth or eighth day the disease begins to mani- 
fest itself by a sensation of weariness, languor, and irregular 
appetite and excretion. These symptoms increase until the 
day preceding the chill, the patient now feeling so bad that he can 
not follow his usual employment; in addition to the symptoms 
named, the patient now complains of soreness of the muscular 
tissues, pain in the back, weight and heaviness in the head, and 
more or less nausea. 

The chill varies in intensity, sometimes it is but slight; 
chilly sensations pass over the body, which after some time 
are attended with flushes of heat; more frequently there 
is well-marked coldness of the surface, and again a well-devel- 
oped rigor. The chill varies in duration from two to four or 
even more hours. During this period the pain in the back 
and limbs becomes more marked, and there is sometimes nau- 
sea and vomiting. 

With the development of febrile reaction, the skin becomes 
hot, the pulse accelerated, the bowels constipated, the urine 
scanty and high-colored, pain in the head, with greatly 
increased pain in back and limbs; sometimes the pain is so 
intense that the patient can not get rest in any position. In 



60 The Eclectic Practice^of Medicine. 

the mild or discrete form, the fever may be about as high as 
common continued fever, though in mild cases, it is sometimes 
very dight. In the severe, confluent form of the disease, the 
fever is generally intense, the pain severe, and the patient 
extremely restless; frequently delirium makes its appearance 
on the second or third day. In some fearfully intense cases 
there is marked torpor of the nervous system from the begin- 
ning, which is speedily succeeded by low delirium or stupor ; 
the skin being hot, pungent, turgid, and dusky, or the heat 
confined to the trunk, the extremities being cold. 

At the end of forty- eight hours from the chill, the eruption 
usually begins to manifest itself in the form of minute, reddened 
papulse, at first on the face, wrists, breast, and where the skin 
is thin and delicate, gradually extending over the entire sur- 
face, becoming complete about the end of the third or fourth 
day. When the fingers are passed over these papulae, they 
feel like small tubercles in the true skin, about the size of a 
pin's head; a minute vesicle forms on the apex of each within 
twelve or twenty-four hours after its appearance, which, 
enlarging, forms the small pox pustule. In the discrete form 
of the disease, these papulae are not very closely set together, 
sufficient room existing between them for their full develop- 
ment; they are usually grouped together in threes or fives, 
with considerable space between the groups. In the confluent 
form they are closely set together, being very numerous, so 
that when developed they press against one another, giving 
rise to erosion of their walls and final coalescence. In the 
mild form, the fever becomes much mitigated upon the appear- 
ance of the eruption; but in the other there is frequently little 
or no decrease in the fever, delirium being present in many 
cases. 

Stage of Maturation. — This stage embraces the period from 
the appearance of the eruption to its full development and 
rupture, usually eight or nine days. The course of the erup- 
tion is as follows: The small vesicle increases in size as it fills 
with a clear whey- colored fluid, and is bound down in the cen- 
ter, giving it an umbilicated appearance. About the fourth 
or fifth day of the eruption, a red areola appears around the 
base of each vesicle; commencing intumescence of the skin 
maybe noticed, and shortly the tissue that held down the cen- 
ter gives way, and the eruption becomes pustular, and of a 
somewhat conical form. From the fifth to the eighth day the 



Vakiola. 61 

pustule maturates, the surface becoming rough and yellow, 
and the cuticle breaking allows a portion of the contents to 
ooze out, which desiccating, forms the scab. At the commence- 
ment of maturation the tumefaction of the skin increases; in 
the confluent form, the swelling being so great as to close the 
eyes and efface all the features. The desiccation of the scabs is 
complete from the eleventh to the sixteenth day of the erup- 
tion, when they commence to fall off. 

During the period of maturation the symptoms vary greatly. 
In the mild or discrete form, the fever is never very intense, 
though it may be continuous, frequently being intermittent, 
appearing only in the after part of the day. In the confluent 
form, the fever is more or less intense and continued; fre- 
quently there is continued restlessness or delirium. In severe 
cases there is" stupor or delirium; the skin is hot, dry, and 
hard; the eruption comes out on the mucous membranes of 
the mouth, nose, pharynx, and sometimes larynx or bronchii, 
attended with tumefaction. This gives rise to difficulty in 
deglutition and respiration, which is increased by the secre- 
tion of a tough, viscid, and ropy mucus, requiring a constant 
exertion on the part of the patient to keep the passages free. 
If this affection of the mucous membrane is severe, we notice 
symptoms of gradual asphyxia, luridity of the lips, duskiness 
of the countenance and sometimes of the entire surface, with 
rapid prostration. 

In some extreme cases, in addition to the symptoms of pros- 
tration above named, the papulae when they first make their 
appearance become dusky, the skin livid, the pulse sinks, 
extremities become cold, and the patient dies before the forma- 
tion of the pustules. In other cases, the areola becomes pur- 
plish and livid, and instead of normal maturation the pustules 
are filled with a sanious fluid, or blood, petechia make their 
appearance between the points of eruption, symptoms of pros- 
tration ensue, and the patient speedily dies. 

On the eighth day of the eruption, or the eleventh of the 
fever, secondary fever ensues. This, in the discrete form, is 
not very severe; but in the confluent is generally as high as it 
was at first. In the last case, it usually lasts from two to four 
days, when it gradually declines ; during this time there is fre- 
quently delirium. In some cases, this secondary fever is ex- 
treme, accompanied by low delirium, a rapid, weak pulse, and 
great prostration, when the patient is in imminent danger. 



62 The Eclectic Practice of Medicine. 

Sometimes complications arise during this secondary fever, as 
inflamation of some part of the respiratory apparatus, the 
brain, mucous membrane of the bowels, etc, which greatly 
aggravate it, and may prolong it for an indefinite time. 

Stage of Decline. — The fever gradually disappearing, secre- 
tion is established from the skin and kidneys. The tumefac- 
tion goes down, and desiccation of the scabs progresses. 
About the fourteenth day of the eruption the scabs begin to 
be detached, but are not entirely thrown off for two or three 
weeks. If there has been no ulceration of the skin, the site 
of the pustule is of a dark, purplish color, giving the skin a 
mottled appearance; this gradually fades away and disappears 
in six to eight weeks, though upon exposure to cold they can 
be noticed frequently for six months. In many cases, at the 
time of the rupture of the pustule, ulceration is established at 
its base in the true skin, which causing a loss of structure, 
and there are pits left in the skin marking the site of the pus- 
tule. As a general rule, the severer the disease the longer the 
convalescence, which presents similar symptoms to that of 
other fevers. 

Complications. — Small pox may be complicated with any 
disease, but generally they are of an inflammatory form. The 
principal complications are of the mucous membrane of the 
bronchial tubes, the substance of the lungs, the bowels, and 
cerebro-spinal nervous system, the symptoms being generally 
well marked. Affections of the eyes are not infrequent; but, 
with the exception of inflammation, treatment will have to be 
postponed until after the disease has run its course. 

Post-Mortem Examination. — If a person dies with small 
pox, it is either because of septic decomposition of the blood, 
or of some complication which has arisen during the progress 
of the disease. In the first instance, we find the blood dark 
and diffluent, with great softening of the tissues, so much so, 
that I have seen cases in which they could not be washed or 
dressed, but had to be wrapped in the sheet upon which they 
died. The external appearance varies, sometimes the eruption 
is exceedingly profuse, but maturation has progressed normally ; 
at others the pustules are filled with sanies, are dark colored, 
with petechias or vibices betwen the pustules, and sloughing of 
parts pressed upon. In the case of complications the local 
lesions will vary according to the character of the disease. 

Diagnosis. — In the early stages of the disease the diagnosis 



Variola. 63 

has to be made between this and measles and scarlatina. This 
is not very easy, yet as measles is almost always attended by 
catarrhal symptoms, cough and watering of the eyes, this will 
be of some assistance. Upon the appearance of the eruption 
the distinction is not difficult, the papulae of small pox being 
firmer and deeper seated than measles, while in scarlatina 
there is merely the exanthematous redness. From varicella, 
the diagnosis is made by the mildness of the fever, the vesicles 
full of serum on the first day of eruption, their irregular 
appearance, absence of the central depression or umbilicated 
appearance, irregular and oblong form, and formation of crusts 
by the fifth day, at which time small pox is just forming its 
areola and commencing to maturate. 

Prognosis. — The prognosis is favorable, except in those cases 
in which evident symptoms of disorganization of the blood 
make their appearance, or those complicated with severe local 
disease. 

Treatment. — This disease has a determinate course to run, 
and therefore can not be arrested. There is no doubt, how- 
ever, but what it may be modified by treatment, and rendered 
comparatively mild, and its duration shortened. If the doc- 
. trine of contagion heretofore advanced is true, means that 
would lessen the intensity of the febrile exacerbation, would 
prevent an increased generation of virus, and the same would 
be accomplished by so keeping the surface that the erup- 
tion could readily be thrown out. low whether these are 
facts or not, I know that when this is accomplished, the erup- 
tion is comparatively light. 

Before the eruption, as we have no positive means of deter- 
mining that it is small pox, we would treat it the same as any 
other fever. For instance: if there was nausea, with indica- 
tions of morbid material in the stomach, an emetic should be 
employed; if there was constipation, a mild cathartic. The 
special sedatives should be employed to lessen the febrile 
reaction, assisted by the frequent use of the alkaline sponge 
bath. The patient should not be kept too warm, neither 
should heating remedies be employed to cause determination 
to the skin. If there is much restlessness, sleeplessness and 
delirium, Opium may be used with advantage. 

If such course is pursued few severe confluent cases will be 
met with. All heating and irritant applications to the skin, and 
internal remedies calculated to produce determination to the sur- 



64 The Eclectic Practice of Medicine. 

face, will increase the eruption and aggravate the disease. When 
the eruption makes its appearance, we continue the same 
treatment, though the sedatives will now be used in small 
doses. The sponge bath, two or three times daily, should still 
be used, and continued until maturation is complete; Castile 
soap and warm water is the best that can be used. Those 
who have never adopted this plan would be surprised to see 
the influence that is exerted upon the system by keeping the 
skin thoroughly cleansed. To prevent pitting, the room should 
be kept dark, and the face not exposed to the action of heat and 
light, in addition, all that is required is the free but gentle use 
of soap and water, and the application of sweet oil, when the 
pustules commence to rupture, to keep the skin soft. During 
the period of maturation the patient needs constant support, 
and should therefore have a light and nutritious diet; corn- 
meal gruel is the best article that I have ever employed. If 
strict cleanliness has been observed, there will be but little sec- 
ondary fever. 

In those cases in which marked lividity of the surface pre- 
sents itself, either before or at the time of the eruption, with 
great nervous prostration, an emetic should be administered, 
and the warm bath prescribed. When there are indications 
of serious lesion of the blood, those antiseptic agents named 
under the head of typhoid fever, should be resorted to. If 
any complication arise, it should be treated as named under 
the particular affection, as the treatment will not generally 
interfere with that for the eruptive fever. 



VARIOLOID. 
This is but a modified form of small pox; the system hav- 
ing been partially impressed by the vaccine disease, the vari- 
olus affection is very mild. The symptoms are those of the 
mildest form of the discrete small pox, though its course is 
shorter and more irregular. The treatment should be the 
same as for variola. 



VARIOLA VACCINA. 

COW POX. 

The existence of the vaccine disease in the cow and its pro- 
phylactic influence against small pox, was discovered by Dr. 



Variola Vaccina. 65 

Edward Jenner, and communicated to the world between the 
years 1775 and 1798. Dr. Jenner first noticed whilst studying 
medicine that in the dairy districts in Gloucestershire there 
was a current opinion that certain persons who had contracted 
a pustular disease from the cow were exempt from small pox. 
His mind was strongly impressed by the fact, and he com- 
menced its investigation. It was not until 1796, however, 
that he became sufficiently convinced to attempt the propaga- 
tion of the disease by inoculation. His first case was entirely 
successful; the disease was transmitted, and two months after- 
ward upon being inoculated with small pox virus, it was found 
not to have the slightest influence. He published the results 
of his investigations in 1798, but they were received with 
incredulity by the mass of the profession ; and met with the 
most bitter opposition from many. The evidence, however, 
soon became so strong that vaccination was adopted with 
eagerness as an invaluable boon, warding off as it did the 
most fell disease of that period. 

Cow Pox in the Cow. — The disease in the cow is of rare 
occurrence, and hardly ever manifests itself except where cat- 
tle are collected together in herds. It was stated by Jenner 
that the disease of the cow originated from the grease of 
horses, being communicated from the heels of the horse to the 
the udder of the cow, by those having the care of them. 
Whether this was the cause or not, it is a well-proven fact, 
that the disease of the horse can be propagated to the cow, 
and thence to man, producing the vaccine disease; and, far- 
ther, that inoculation with the matter from the horse will prove a 
prophylactic, if it is not the same disease. The Edinburg Journal 
of Medical Science states: " That the matter in use at Vienna, 
from 1799 to 1825, was partly British vaccine and partly 
originated from the grease of a horse at Toulon, without the 
intervention of a cow. The effect was so similar in ever} 
respect that they were soon mixed ; that is to say, after sev- 
eral generations, and in the hands of innumerable practition- 
ers, it was impossible to distinguish what was vaccine and 
what was equine." According to Dr. Jenner, the true cow 
pox shows itself upon the nipples of the cow, in the form of 
irregular pustules. At their first appearance they are com- 
monly of a palish-blue color, or rather of a color approaching 
to livid, and surrounded by an erysipelatous inflammation. 
They frequently degenerate into phagedenic ulcers, the ani- 



66 The Eclectic Practice of Medicine. 

raal appears indisposed, and the secretion of milk is much 
lessened. The cow is subject to other pustular sores on the 
nipples, which are of the nature of common inflammation, 
and possess no specific quality. These are free from all bluish 
or livid tint, and no erysipelatous inflammation accompanies 
them. They desiccate quickly, and create no apparent dis- 
order in the animal. 

Vaccination. — This is an extremely simple operation, and 
yet from want of care on the part of the practitioner, failure 
to introduce the lymph is of quite frequent occurrence. Vac- 
cination may be performed with the lymph taken from the 
vaccine vesicle from the fifth to the ninth day, and this is 
probably the most effectual way of transmitting the disease. 
It is generally effected, however, from the scab, it being 
macerated with water, and thus introduced, or a minute por- 
tion of the scab is inserted under the skin, and being rendered 
soluble by the fluid of the part, is thus absorbed. In perform- 
ing vaccination with the lymph or macerated scab, we dip 
the point of the common lancet in the matter, and having 
exposed the arm to the insertion of the deltoid, we make a 
number of small punctures, just sufficient to elevate the epi- 
thelium, when an additional quantity of the virus can be 
applied and pressed into the punctures with the lancet: a 
piece of adhesive plaster should then be applied to protect the 
part. In introducing the scab, the lancet should make an 
incision so as to elevate the epidermis in the form of a flap, 
the piece being introduced it can be retained with adhesive 
plaster. 

Preservation of Vaccine Matter. — Vaccine matter is ex- 
tremely liable to spontaneous decomposition, and can not be 
kept longer than from two to six months under the most 
favorable circumstances. The lymph may be preserved for 
several days, by placing it between two pieces of ground glass, 
fitting each other accurately, or by cutting pointed pieces of 
quill and dipping the points in the lymph two or three times, 
allowing it to become dry each time, and keeping them from 
the action of the atmosphere; in this case vaccination is per- 
formed by making a small puncture with the lancet, and 
inserting the pointed extremity of the quill, which should 
remain in the puncture ten or fifteen minutes. The scab is 
best preserved by taking two flat pieces of white wax, exca- 
vating upon their surfaces a sufficient cavity for the reception 



Varicella. 67 

of the scab, and then applying them closely together; in order 
to render the protection more effectual a warm iron may be 
passed around the edges, and afterward three or four coats of 
collodion or even glue may be applied. 



VARICELLA. 

CHICKEN POX. 

Symptoms. — This is the mildest of the eruptive fevers, 
rarely, if ever, endangering life, and requiring but the sim- 
plest treatment. Like the other diseases of this class, it is 
propagated by specific contagion, the period of inoculation 
being from six to nine days. The disease is frequently associ- 
ated with the epidemic prevalence of small pox, and hence 
has been supposed by some to be a modification of that dis- 
ease. It usually commences with a tolerably well-denned 
chill; fever succeeds of a more or less marked charac- 
ter, and continues with remissions for twenty-four or forty- 
eight hours before the appearance of the eruption. With 
its appearance the fever abates, and the little patient feels 
quite comfortable. 

The eruption appears first as small, red, slightly elevated 
spots usually of an oblong figure, with a flat and shiny sur- 
face; in a few hours a transparent vesicle is formed upon this, 
which upon the second day is filled with whitish lymph, and 
upon the third, having obtained their full size, about one- 
fourth of an inch in diameter, straw-colored. Many of them 
are ruptured by the fourth day; those which continue become 
puckered at their margins, and the lymph concreting, a brown- 
ish scab is formed, which is detached the seventh or eighth 
day. Many times there are successive crops of eruption, 
so that the disease may be observed in all its stages in the 
same individual, and the time is consequently prolonged. 

Diagnosis. — This affection is distinguished from small pox, 
the only disease with which it could be confounded, by the 
formation of the vesicle the first day of the eruption, no de- 
pression in the center, and their rapid maturity. 

Treatment. — In this case, we direct a general sponge bath, 
followed by a hot foot bath, and the administration of some 
mild diaphoretic infusion, as of Asclepias, Eupatorium, Hed- 
eoma, etc. If the bowels are costive, it is well enough to 



68 The Eclectic Practice of Medicine. 

administer a mild cathartic ; or, if the fever is high, #, Tinc- 
ture Veratrum, gtt. x; Essl. Tincture Asclepias f3ss ; Aqua 
3iij ; M., and give a teaspoonful every hour to a child five or 
six years old. To relieve the itching that is so intolerable 
in some cases, #, Glycerine, Rose water aa 3v; Subnitrate 
Bismuth ;gr. xxx ; M. and use as a local application. 



RUBEOLA. 



MEASLES. 



This is said to be a disease of childhood, but experience 
teaches us that the adult is just as liable to contract it, and 
that it is dangerous in proportion to the age of the patient. 
Like the other eruptive fevers, it is propagated by contagion, 
and one attack gives immunity from the disease ever after- 
wards. The period of incubation is from seven to fourteen days. 
Symptoms. — Measles usually commence with a chill, 
sometimes slight, sometimes amounting to a rigor; to this 
Bucceeds catarrhal fever ; there is frequent sneezing, Avith 
stuffing of the nose, redness, watering and turgidity of the 
eyes, sensibility to light, hoarseness, and dry, troublesome 
cough. The appetite is lost ; tongue coated white, and loaded 
at base ; unpleasant taste in the mouth ; sometimes nausea 
and vomiting ; and general arrest of the secretions. The fever 
is sometimes intense, with severe pain in the head, back and 
limbs, and great irritability ; it is remittent in its character^ 
the exacerbation being in the after part of the day. 

Upon the third or fourth day from the first commencement 
of the disease, the eruption makes its appearance ; first, on 
the face, neck and breast, then on the arms, hands and abdo- 
men, and last on the lower extremities. At this time there is 
marked turgidity of the countenance, particularly of the eyes ; 
the tip and edges of the tongue are red, its center and base 
loaded with a dirty fur, and the fauces exhibit reddened 
patches, resembling the cutaneous eruption. The eruption at 
first resembles very much the bites of fleas ; as they become 
developed, they are elliptic and irregular in form, slightly 
elevated above the skin, of a crimson or lively red color which 
is gradually shaded off into the adjacent skin, and slightly 
rough to the touch ; when pressed by the finger they moment- 



Rubeola. 6# 

arily lose their color, which returns rapidly upon removing 
the pressure. The more acute the fever, the greater the erup- 
tion, and the more intense the disease. 

With the appearance of the eruption, the cough is many 
times markedly increased, and becomes very troublesome. 
There is more or less difficulty of breathing, which sometimes 
depends upon determination to or congestion of the larynx, at 
others, of the bronchial tubes, and again of the parenchyma 
of the lungs. During the period of efflorescence, the fever 
usually continues unabated, indeed, in many cases, all the 
symptoms become aggravated as the disease progresses. 

On the seventh or eighth day from the commencement, the 
eruption begins to decline, and the febrile symptoms to disap- 
pear, with reestablishment of secretion, and furfuraceous de- 
squamation of the epidermis. 

Measles are severe in proportion to the extent of involve- 
ment of the respiratory apparatus, and hence constant care in 
the examination of these complications is necessary. The 
sequela, which are so much dreaded, are chronic inflammation 
of the larynx and bronchi, or irritability of the pulmonary 
tissue, causing determination of blood, and eventuating in 
phthisis. The disease undoubtedly affects the constitution of 
the blood in many cases, the reparative or reproductive power 
being so injured that the patient is feeble and liable to any 
cachectic disease. 

Diagnosis. — Measles is diagnosed from miliary fever by the 
phlyctena containing a serous fluid in that affection ; from 
in the early stage, by the catarrhal symptoms, and larger 
urticaria by the itching and larger papulae; from small pox, 
stigmata of measles; from scarlet fever by the smooth, scarlet 
redness and prominent affection of the throat. 

Treatment. — Notwithstanding measles has been attended 
with marked fatality for the last few years, I claim that the 
treatment is simple and easy. We desire to shorten the 
period of precursory fever, to get an early appearance of the 
eruption, and guard against irritation of the mucous surfaces. 
To do this, I direct, in many cases, simply an infusion of one 
part Lobelia herb to three parts of Asclepias or Pennyroyal. 
The sponge bath should be used sufficiently often to keep 
down the heat of the surface, and the hot foot bath about the 
time the eruption is expected. Or, &, Tincture Yeratrum, 
gtt. xv ; Tincture Gelseminum, f3j ; Essential Tincture Lobelia, 



70 The Eclectic Practice of Medicine. 

i'3ss, Aqua, 3iv; M., and give a teaspoonful every hour until 
the fever abates, and in smaller quantities and at longer inter- 
vals afterwards. 

In those cases in which the eruption is tardy in making its 
appearance, with much affection of the respiratory apparatus, 
an emetic of the Acetous Emetic Tincture will prove highly 
serviceable, as it will also in those cases in which there is 
retrocession. For the relief of the irritation of the respira- 
tory mucous membrane, and harassing cough, which is some- 
times so prominent a feature of the disease, various agents are 
employed; I have used the Compound Tincture of the Oils 
of Lobelia and Stillingia with advantage, in doses of one 
drop on a luinp of sugar, every three Lours, and a free 
application of the same to the throat or chest. If there is 
marked dryness of the respiratory passages, the nauseant 
expectorants must be employed; and here the Acetous Tinc- 
tures of Lobelia and Sanguinaria, with simple syrup, will be 
found preferable. Demulcents are always of benefit, and 
should be employed as drinks. Inhalations prove beneficial, 
the vapor of water, of an infusion of Lobelia, or of Vinegar, 
or of the narcotics, Opium, Belladonna, Hyoscyamus, etc., or 
the sedatives. A moist atmosphere is of the utmost impor- 
tance, hence a person suffering from measles should never be 
kept in a stove-room, unless great care is employed to keep 
the air moist. For the cough I have used with advantage, 
R, Syrup Primus f3hj; Tincture Lupuli, Syrup Lobelia, 
aa fgij; Tincture Hyoscyamus, fgi; M., a teaspoonful every 
hour or two hours to a child five or six years old. Or, take 
of Trillium Pendulum and Asclepias, aa, make a strong in- 
fusion by macerating with gentle heat for three or four hours, 
and express ; add to this Syrup of Lemon to render it pleas- 
ant, and administer ad libitum. 

In some cases w T e observe marked depression of the system, 
entire loss of appetite, furred tongue, more or less fissured, 
with great dullness. In this case we will find, on examination, 
deficient secretion of urine, which if it continues will lead to 
a fatal termination. Here, an infusion of Hair Cap Moss, or 
other mild diuretics, with counter-irritation to the loins, will 
be followed hj marked relief. Much care is required after the 
disease has subsided in order to confirm convalescence. The 
clothing should be warm, and the child not permitted to expose 
itself to draughts of air. If this is attended to, and the secre- 



Scarlatina. 71 

tions kept free, there is no more danger from measles than 
from any other disease. 



SCARLATINA 



SCARLET FEVER. 



This is essentially a disease of childhood, and few persons 
will take it after the age of twenty. Unlike measles, it is also 
milder, as the patient is older. It is propagated by specific 
contagion, either by inhaling the exhalations, or contact with 
the clothes of the patient. In some seasons it becomes epi- 
demic; doubtless because the poison is so intense as to be 
propagated readily and at a considerable distance, and the con- 
dition of the atmosphere is favorable to the ready propagation 
of a zymotic disease. Scarlatina has been divided into three 
forms : S. Simplex, S. Anginosa, and S. Maligna, differing in 
their intensity, severity of symptoms, and fatality. In some 
seasons the disease will present the character of the first exclu- 
sively, in others it will be of the anginose form, and again 
every case will be malignant. 

Symptoms. — From six to eight days elapse after exposure 
before the disease makes its appearance, and it is usually ush- 
ered in with a chill. In scarlatina simplex the chill is not very 
well marked, and lasts but a short time. The fever following 
presents the common symptoms, increased heat of skin, arrest 
of secretion, frequent pulse, loss of appetite, etc. In the 
course of from six to twenty-four hours, the eruption makes 
its appearance in the shape of patches of efflorescence upon 
the face and neck, then extending to the body. If the erup- 
tion is minutely examined, it will be found to consist of an 
infinite number of small red points, the rose -colored ground 
being simply the base upon which they stand. Soreness of 
the throat, with slight difneuhy of deglutition, appears at the 
commencement, though not usually severe, or accompanied 
with tumefaction. For nineteen to forty-eight hours after 
the appearance of the eruption the fever continues as before, 
but then rapidly abates, and in from three to five days the red- 
ness disappears, and is followed by branny desquamation of 
the cuticle. 

In scarlatina anginosa, the chill is usually marked, there is 
nausea and vomiting, pain in the head and back, thirst, etc. 



72 The Eclectic Practice of Medicine. 

The fever which follows is intense, the skin is dry, husky, and 
burning, the eyes dry and painful, the face congested and 
tumid, bowels constipated, urine is scanty, frequently voided, 
and high-colored, and marked irritability of the nervous sys- 
tem. Soreness of the throat, with difficult deglutition is com- 
plained of from the first, and on examination we find the 
fauces tumid and red, and the tonsils somewhat swollen. The 
nares are frequently implicated with the angina, and there is 
consequent stuffing of the nose, with difficult respiration and 
consequent increased restlessness. The eruption sometimes 
makes its appearance during the latter part of the first day 
of fever, but more frequently not until the second or third 
day ; about the third or fourth day it has reached its hight. 
At the commencement there appears slight tumefaction of a 
portion of the surface, which gradually assumes a rose-red 
color, and the minute red points are developed. These patches 
increase in size until the greater portion of the surface is 
involved. During the eruption there is an expression of anx- 
iety and suffering; the child is restless and uneasy, and sleep- 
lessness which resists the usual means of rest, is caused by the 
heat and stinging of the surface and soreness of the throat. 

The throat affection is here the most prominent feature ; 
the soreness increases, the mucous membrane and subjacent 
tissue is engorged and tumid, and the secretion from the mu- 
cous follicles and salivary glands so viscid and tenacious as to 
cause great distress. In some cases, ulceration commences by 
the fifth or sixth day of the disease, and the secretion is diffi- 
cult of removal and exceedingly offensive; occasionally the 
ulceration assumes a phagedenic form, and speedily terminates 
the life of the patient. Frequently enlargement of the cer- 
vical lymphatics commences from the third to the sixth day, 
and if not promptly treated terminates in inflammation and 
suppuration. The fever, under appropriate treatment, com- 
mences to abate when the eruption has made its appearance, 
and disappears entirely by the fourth or sixth day, when de- 
squamation commences. As this progresses, the surface 
becomes paler, the epidermis exfoliating in whitish scales, or 
in large pieces when it is thick ; sometimes desquamation is 
retarded for two or three weeks. 

Scarlatina maligna might be divided into two kinds, the dis- 
tinctive symptoms being marked. In the one case there is 
marked evidence of prostration from the commencement. 



Scarlatina. 73 

The chill is greatly prolonged, and the child seems dull and 
stupid, the countenance vacant or besotted. Febrile reaction 
conies up slowly, the body becomes hot, the heat being pun- 
gent, but the extremities are cold ; the pulse is frequent, but 
soft and fluent, or else small and wiry. Frequently there is 
nausea and vomiting, sometimes diarrhoea. The tongue is 
broad, flabby, and covered with a foul, dirty mucus and the 
patient has difficulty in controlling its movements. The erup- 
tion makes its appearance slowly, the redness being more or 
less dusky. The throat affection possesses the same character- 
istics; there is difficult deglutition and respiration, the mucous 
membrane presenting a dusky, tumid appearance. Ulceration 
is of frequent occurrence, their surface being foul, the edges 
ragged, and a strong tendency to phagedena. Enlargement of 
the cervical lymphatic glands is very common, with a strong 
tendency to the formation of a diffusive abscess, and, if the 
patient lives, to the formation of secondary abscesses. As the 
disease progresses, the symptoms are all of a typhoid charac- 
ter; there is the dark tongue, sordes on the teeth, feeble pulse, 
great oppression of the nervous system, tendency to diarrhoea, 
and tymphanitis, etc, 

In the second case, the disease exhibits but few, if any, pre- 
monitory symptoms. The child is attacked suddenly; the 
chill lasting but a quarter or half an hour, is not well-marked, 
and is succeeded by the most intense febrile reaction. The 
skin is intensely hot, dry and husky; the mouth parched and 
dry; the eyes injected, dry, brilliant and painful. The patient 
is either delirious, or suffers such intense pain as to be almost 
unconscious of what passes around him. There is nausea and 
vomiting, the irritation being sometimes so intense, that no- 
thing can be retained on the stomach. In these cases the pati- 
ent is frequently exhausted by the intense reaction, and dies 
before the appearance of the eruption, or during the time that 
nature is trying to throw it on the surface. 

In the two last forms of the disease, and sometimes in the 
simple form, we observe a want of power upon the part of the 
system to determine the eruption to the surface. In such case 
the skin appears tumid and dusky, there is tendency to cold- 
ness of the extremities, and marked oppression of the nervous 
system. In such case, prompt measures must be taken to 
bring the eruption to the surface, or the patient will die. 
Again, we observe cases in which the eruption comes out, but 



74 The Eclectic Practice of Medicine. 



from some cause it retrocedes; in this case the same alarming 
symptoms manifest themselves. In other cases, the anginose 
affection is so severe, that it seems that the patient has not 
sufficient power to carry on respiration ; sometimes the diffi- 
culty depends upon the secretion of a viscid, tenacious mucus. 

Diagnosis. — Scarlet fever is diagnosed from other diseases of 
the skin by the rose-colored efflorescence, upon which are the 
innumerable small red points. A marked characteristic of the 
disease is the fact that the redness is effaced by pressure, and 
does not return for some little time. Thus, by taking a pencil 
or the finger-nail w r e can write our name, which remains for 
a moment, and then gradually fades out. 

Prognosis. — In the simple and anginose form of the disease, 
the prognosis is favorable. In the malignant form, unless the 
treatment is prompt and effective, the prognosis is unfavorable. 
In all cases, if the eruption becomes dusky, if coma or typho- 
mania ensues, or if the tongue becomes brown and foul, it is 
unfavorable. 

Sequelae. — Among the most frequent of the sequeke of 
scarlet fever, are diseases of the kidneys, consisting of simple 
exhaustion and want of power to secrete, chronic inflammation 
and albuminaria. In the first we notice a marked dullness and 
hebetude, the appetite is poor, the bowels irregular, marked 
debility and tendency to cachectic diseases, the blood being 
greatly impaired. In the second, the pulse is hard and fre- 
quent, the dryness and huskiness of the skin continues, there 
is pain and soreness in the back and loins, the appetite is poor, 
the tongue dry, whitish, and fissured. In the third, dropsy 
makes its appearance when the child is supposed to be conva- 
lescing. Continued disease of the throat, and irritability and 
enlargement of the cervical lymphatic glands is sometimes 
observed. Ozcena, w T ith weakness and irritation of the eyes, 
and chronic disease of the ears, attended by purulent discharge 
and partial deafness, is not unfrequent. 

Treatment. — In the treatment of this disease it is well to 
have some well defined line of action — to determine exactly 
how we can benefit our patient. We know, by experience, 
that the higher the fever, and the longer it continues before 
the appearance of the eruption, the greater the danger, and 
that the case also becomes critical in proportion to the amount 
of eruption and arrest of secretion. Thus, in all cases, it is 
good practice to use such means as will control the primary 



Scarlatina. 75 

fever, and favor the early appearance of the eruption. I have 
already mentioned, when speaking of small pox, that keeping 
the secretions free during this period lessened the amount of 
eruption, this is the case here ; hence depurants are advan- 
tageous. 

In the simple form of the disease, I usually order the Vera- 
trum, with infusion of Asclepias, or other mild diaphoretic, 
and a small quantity of Chlorate of Potassa. The alkaline 
bath should be employed sufficiently often to keep down the 
heat of the skin, and render it soft and pliable, an infusion of 
Hair Cap Moss with Acetate of Potash being sufficient after 
the eruption has made its appearance. For the throat, I direct 
a gargle of a solution of Chlorate of Potash, a flannel cloth 
wrung out of cold Vinegar being applied to the throat. 

•In scarlatina anginosa, I put my patient on the use of Tinc- 
ture of Veratrum and Aconite, in small doses, largely diluted, 
and frequently repeated. In addition, I direct for a child five 
years old, #, Ext. Belladonna gr. x ; Alcohol 3\j ; Chlorate of 
Potassa 3ij ; Hydrochlorate of Ammonia 3j ; Syrupus Auran- 
tii 3iv; M. Of this the dose is ateaspoonful every two hours, 
until the influence of the Belladonna is marked, then continue 
without that remedy. The alkaline bath should be used suf- 
ficiently often to remove the excess of heat; if the skin is very 
dry and harsh, with pungent heat, the oleaginous or glycerine 
friction, following with Castile soap and water, will prove 
advantageous. To the throat externally, I direct a flannel 
cloth wrung out of cold Vinegar, and covered with a dry one, 
and changed as often as necessary. As a gargle, use a satu- 
rated solution of Chlorate of Potassa, alternated with the 
Hydrochlorate of Ammonia. As soon as the eruption makes 
its appearance, use an infusion of Hair Cap Moss acidulated 
with Nitric Acid. 

If the throat affection has become firmly established, with 
marked tumefaction, inhalations of equal parts of Vinegar and 
Water is beneficial. Demulcents used frequently, to remove 
the unpleasant sensation of dryness, are also important. If 
there is marked tendency to enlargement of the external lym- 
phatic glands, I employ local applications of #, Tincture Lobe- 
lia, f3iij ; Tincture Aconite, Tincture Arnica, aa f3j; M. Or 
take a strong infusion of the Lobelia herb, and make a poul- 
tice of Wheat-bran; Arnica can be added if there seems to be 
a necessity for stimulation. 



76 The Eclectic Practice of Medicine. 

In the first case of scarlatina maligna described, I employ 
the Belladonna in the formula above named, with the Tinct- 
ure of Xanthoxylum as a stimulant. Stimulant frictions, as 
of dilute Tincture of Capsicum, to the entire surface is highly 
important, and to the extremities it should be used of suflicient 
strength to stimulate free capillary action. At the end of the 
first twelve hours, usually, the special sedatives can be com- 
menced, in small doses, and continued until the fever has 
abated. If, however, there is nausea, or if the prostration is 
extreme, the circulation being feeble, I employ the emetic, 
the Acetous Tinctures of Lobelia and Sanguinaria, equal 
parts, being preferable agents. The emetic, to be attended 
with favorable results, should be thorough; and its action 
prolonged until relief is obtained. In the second form of the 
disease described, nauseant doses of the Acetous Tinctures of 
Lobelia and Sanguinaria, repeated frequently, and continued 
until relaxation becomes manifest, and then carried to thor- 
ough emesis, evaporating lotions to the head, strong counter- 
irritation to the spine, and cloths wrung out of hot Mustard 
water, or dilute Tincture of Capsicum, is the only treatment 
I have found successful. This quiets the excessive reaction 
when, under the means named above, the eruption appears 
and the disease runs a regular course. In all forms of scarla- 
tina, if after partial sedation is produced, there appears to be 
a want of power to carry on the natural processes of life, 
Quinia is an important remedy. There are cases in which 
the patient seems comfortable, but is worse towards evening; 
in such cases it is of marked benefit. If the eruption fails to 
make its appearance, or appears slowly, or shows a tendency 
to retrocede, or is dusky in color, or there is much prostration 
and torpor of the nervous system, I use the emetic. The 
Acetous Emetic Tincture is the best preparation, and it should 
be used thoroughly. In the first three cases named, I fre- 
quently apply a blanket wrung out of hot water and Mus- 
tard to the entire surface, as a pack, to stimulate capillary 
circulation. 

When the mucous membrane of the throat is tumid and 
dusky, Tincture of Myrrh added to the gargle will prove 
beneficial. In cases of extreme congestion, or where from 
greatly increased secretion of mucus, respiration is interfered 
with, I use the emetic above named. It may be set down as 
a fixed rule in this disease, to which there are but few excep- 



Scarlatina. 77 

tions, that if alarming symptoms of any kind make their 
appearance from feeble capillary circulation, or congestion, as 
is generally the case, the emetic, by its revulsive and stimu- 
lating influence, is the best remedy that can be adopted. 

The enlargement of the lymphatic glands is a source of much 
difficulty in this form of the disease, appearing frequently when 
the patient is apparently convalescent. The means previ- 
ously named may be employed with advantage; if it fails, the 
swelling being indolent, a series of small blisters, as large as a 
quarter, around it, or, in some cases, one applied to the sur- 
face itself proves beneficial. A poultice of a strong infusion 
of Elder Bark and Bran is good, as is also one made with 
the decoction of Dogwood, or with new Beer; a poultice 
of pulverized Hydrastis, or this and Bayberry, equal parts, 
or of Sanguinaria and Wheat Bran, has also been successful. 
If it is manifest that suppuration will ensue, no good can 
result from means to promote resolution ; speedy suppuration 
is desirable, and to promote it the common means may be 
employed, with the addition of such stimulants as will pro- 
mote free circulation in the part. The great danger being in 
the formation of diffusive abscess, and purulent absorption, 
this must be closely watched. The bitter tonics, Quinia, stim- 
ulants, and Iron, should be freely used, and a bland nutritious 
diet recommended. 

Convalescence must be managed with care in the severer 
cases, but the rules already laid down will be sufficient for the 
young practitioner; those older have the benefit of experi- 
ence. The sequelae will be spoken of under their appropriate 
heads. 



78 The Eclectic Practice of Medicine. 



CHAPTER II. 

DISEASES OF THE RESPIRATORY APPARATUS. 

The respiratory apparatus it will be recollected consist of 
the nares, larynx, trachea, bronchi, parenchyma of the lungs, 
and the investing serous membrane in the pleura. Each of 
these parts may be the seat of disease, either acute or chronic, 
or two or more parts may be involved at the same time. We 
diagnose these diseases by general symptoms, and "by physical 
signs; the first, arising from change of function dependent 
upon the disease, and the influence of it upon the S3 T stem, are 
never constant, and in some of these affections entirely insuffi- 
cient to determine their character; the physical signs being 
palpable alterations of sound, movement, shape, etc., are 
always constant and unfailing. The consideration of physical 
diagnosis, therefore, demands a prominent place in this 
chapter. 



. PHYSICAL DIAGNOSIS. 

Under this head might be comprised the conformation of the 
thorax, respiration, cough, sputa, and the information obtained 
from percussion and auscultation . Some of them will be con- 
sidered with the general symptoms in the consideration of the 
disease, but it is well enough to study them in a group. 

Conformation op the Thorax. — As a general rule the 
healthy thorax presents a marked uniformity in the contour 
of each side, the outlines being rounded and smooth. As dis- 
ease is very frequently confined to one side, we compare the 
sound with the unsound side, and thus readily detect any 
alteration in shape. It is only in chronic affections that we 
notice marked changes ; it is true, that in pleurisy the effusion 
will sometimes be rapid and in large quantity, causing bulging 
of the intercostal spaces, but this is the only case. The size 
is increased from the presence of effusion, or from emphysema ; 
circumscribed enlargement may be caused by a tumor, or 
an aneurism. It is diminished in those cases in which the 



Diseases of the Respiratory Apparatus. 79 

structure of the lung is destroyed, as in phthisis, and suppura- 
tive innaination, and in a less degree by extensive solidifica- 
tion. 

Respiration. — The extent and freeness of the respiratory 
movement, determines to some extent the capability of the lungs 
to properly perform their function. To determine this, we 
sometimes examine the movement of the wails of the thorax 
and abdominal muscles ; if it is necessary we measure the 
amount of thoracic expansion, by drawing a tape line from the 
spinous process, following the rib to the center of the sternum ; 
the difference in measurement between expiration and inspi- 
ration, determines the capability of that side of the thorax. 
Respiration normally is botli thoracic and abdominal ; in dis- 
ease it may be either the one or the other. Thoracic respira- 
tion occurs in cases of infiamation of the diaphragm, or its 
pleura, or of the upper abdominal viscera, or peritoneum. It is 
abdominal in pleurisy, pericarditis, in extreme debility, and in 
apoplexy. Respiration is increased in frequency from two 
causes: 1st, in consequence of an increased frequency of the 
circulation, in which it bears a normal relation to pulsation, 
one to four: and 2d, in disease of the respiratory apparatus, 
there not being necessarily any proportion between the fre- 
quency of respiration and pulsation. A slow and free respi- 
ration indicates an easy circulation of the blood, sound lungs, 
and an unimpaired distension of them. If the respiration is 
large and attended with difficulty, much exertion being neces- 
sary, it indicates loss of nervous power, and approaching coma 
or stupor. The short respiration, when unattended with 
pain, is a very certain symptom of obstruction of the lungs, as 
in hepatization, phthisis, hydro-thorax, etc. 

Difficult respiration or dyspnoea is manifested by the patient's 
laboring for breath : generally they assume a sitting or upright 
posture, grasping some object firmly by the hands to fix the 
shoulders, and thus give greater power to the inspiratory mus- 
cles. It is caused by contraction of the air passages, efface- 
raent of the air cells, disease of the circulatory system, causing 
engorgement of the lungs, and want of innervation. It may 
come on gradually or insidiously, or it may be violently sud- 
den. When continuous, though but slight, it is singularly 
fatiguing and exhausting; but when severe, even when par- 
oxysmal, it causes intense suffering, attended, with a feeling o± 
impending death. In every variety of difficult respiration the 



80 The Eclectic Practice of Medicine. 

circulation through the lungs is impeded, hence a marked 
change in the pulse from this cause. Respiration in health is 
inaudible to the ear away from the chest, therefore, when 
heard it becomes an evidence of disease. The stertorous or 
snoring respiration in disease, is symptomatic of a paralytic 
state of the lungs, as in apoplexy, congestion of the brain, 
coma, etc. ; though occasionally it depends upon an accumu- 
lation of mucus, pus, or blood in the bronchia. The sibi- 
lant respiration is observed in diseases in which there is 
contraction of the air passages, with dryness ; when marked, 
it indicates spasmodic contraction ; or it may arise from an 
exudation upon the surface of the mucous membrane, render- 
ing the caliber smaller, dryness of the air passages being 
present in all cases. The crepitant respiration indicates accu- 
mulations of a very tenacious mucus or pus. 

Cough. — Coughing arises from an irritation of the sensitive 
nerves distributed to the various parts of the respiratory appa- 
ratus. The purpose fulfilled by the act of coughing, is the 
removal of irritating matter which may be in the air-pas- 
sages,, and in a majority of cases it directs our attention to 
this part of the system as the seat of disease. It may, how- 
ever, be sympathetic, arising from disease of the stomach, 
liver, and other abdominal viscera. As the tone or special 
character of the cough varies, according to the condition of 
the organs by which it is produced, this change in its charac- 
ter becomes an element in diagnosis. A hollow or barking 
cough makes the impression on our mind, that there is lack 
of expulsive power, and a want of tonicity in the respiratory 
organs. It is heard in the last stages of consumption, bron- 
chitis, and sometimes in nervous affections. When sharp or 
ringing it is dependent upon disease of the larynx A hoarse 
cough is dependent upon some relaxation, with increased 
secretion, in the larger air-passages. It is observed in incipi- 
ent catarrh, croup, chronic laryngitis, and angiuose affec- 
tions. In asthma the cough is wheezing; in certain diseased 
conditions of the larynx it is belching; and paroxysmal in 
whooping-cough and hysteria. It may be dry, indicative of 
want of secretion; or humid and moist, showing that secre- 
tion has taken place. 

If the surface of the chest be auscultated during the cough 
of a healthy person, a short, dull, and indistinct and diffused 
sound, quickly produced, is heard, attended with a sensation 



Diseases op the Respiratory Apparatus. 81 

of succussion in the interior of • the thorax. The morbid man- 
ifestations of pulmonary cough are three : bronchial, cavern- 
ous, and amphoric. The bronchial cough is harsher and 
more concentrated than the cough in health : it is met with 
wherever there is an unnatural density of the lungs, when they 
are compressed by fluid, or when the bronchi are enlarged : 
so in phthisis, pneumonia, pleurisy, and dilation of the bron- 
chi in chronic bronchitis. The cavernous cough has a hollow 
and metallic character, and gives the sensation of being pro- 
duced in a small excavation ; there is a strong impulse in its 
transmission to the ear, and it is commonly associated with the 
cavernous rhoncus. The amphoric cough is loudly resonant 
and metallic in its character, and is met with where there are 
large tubercular excavations. 

Sputa. — Much may be learned regarding disease of the res- 
piratory organs by a critical examination of the sputa. We 
form an opinion of whence the sputa comes from the exertion 
used in raising it. Thus spitting is the act by which the 
saliva and other matters in the mouth are ejected. By hawk- 
ing, the mucus accumulated in the posterior nares, pharynx, 
and fauces is got rid of. This is attended with a peculiar 
inspiratory effort, and followed by a guttural cough. Expec- 
toration is the effect of cough, and indicates that the matters 
raised proceed from some part of the respiratory apparatus 
below the glottis. 

The character of the sputa may be studied with reference to 
quantity, quality, consistence, form, composition, color and odor. 
The sputa is scanty in the first stages of active inflammation of 
the lungs, bronchi, larynx, pharynx, and posterior nares, and 
is frequently entirely wanting. It is also scanty in some cases 
of chronic disease — as bronchitis, laryngitis, phthisis, etc., the 
cough being dry and rasping. It is more copious toward the 
close of acute disease, and very abundant in many chronic 
diseases of these organs — as in broncorrhoza, where a pint or 
quart of mucus is thrown off in the course of twenty-four 
hours. In consistence it is serous or watery in the forming 
stage of bronchitis, pulmonary congestion, and vesicular 
emphysema. It is mucous and more or less viscid, as the 
result of acute inflammation of the mucous lining of the air 
tubes, as we see in bronchitis, pneumonia, and laryngitis. It is 
purulent as seen in the third stage of pneumonia and phthisis 
pulmonalis; or a muco-pus, as in some cases of bronchitis. 
6 



82 The Eclectic Practice op Medicine. 

It sometimes contains small roundish masses, either tubercles 
or desiccated mucus — the difference being determined by the 
cheesy consistence of the first, and the tenacity of the second 
when rubbed down with water. Blood, either fresh, bright 

andfluid, or dark, clotted or broken down, is frequently a con- 
stituent. 

The form of the sputa is owing very much to its consist- 
ence. Thus, if very viscid, it will be elongated and stringy, 
as we observe in acute bronchitis. It may be frothy, flat- 
tened and run together in the vessel, which is characteristic of 
pneumonia; or it may be in distinct rounded and almost hemi- 
spherical masses, as in the expectoration of tubercles in 
phthisis pulmonalis; or they may assume the shape of the 
cavity from which they were raised, as in pseudo-membrane- 
ous laryngitis, the bronchitis of measles, and sometimes in 
chronic bronchitis and phthisis. The sputa is composed of 
the natural secretion of the mucous membrane of the air pas- 
sages varied with the altered products of secretion, and with 
the admixture of extraneous matters, as blood, tubercular 
matter, etc. 

In color it is white or ashen in the beginning of acute affec- 
tions of the lungs, pulmonary congestion, and asthma. When 
yellowish or greenish, it indicates a decrease of the inflamma- 
tion; and especially if it be thick, a resolution of the disease. 
The rusty sputa, looking as if it had been tinged with the rust 
of iron, is characteristic of pneumonia where much conges- 
tion exists. Sputa streaked with blood is indicative of the 
existence of a high degree of inflammation in pneumonia ; it 
is of frequent occurrence in sthenic bronchitis, and sometimes 
in chronic bronchitis, though here it is an unfavorable symp- 
tom. In bronchitis, and the first stage of phthisis pulmon- 
alis, the sputa has a faint and sweetish smell. When the 
secretion is copious, as in catarrh and bronchitis, the smell is 
sickening; when purulent matter is expectorated it is foetid; 

ga ngrene of the lungs it is decomposed and putrid. In some 
cases, the sputa has been known to have a urinous odor ; in 
others it was bitter, and showed traces of bile, an hepatic 
abscess having opened into the thorax. 

auscultation and percussion. 

We derive the greatest amount and most positive informa- 
tion in diseases of the lungs from auscultation and percussion. 



Percussion. 83 

The first may be defined to be the act of listening to sound 
formed within the body by the movement of its different 
parts. The second, to the sounds heard when a portion of the 
body is struck upon. 

Percussion. — Percussion may be either mediate or direct; 
In the first, something is placed between the instrument 
striking and the part struck; in the second, the blow is imme- 
diately upon the body. We perform percussion of the thorax 
usually by placing one or two fingers of the one hsmd flat upon 
the surface, and striking with the fingers of the other hand, 
bent at a right angle. Much care must be used in adapting 
the hand to the chest, that it lies evenly and becomes as it 
were a part of the wall, and in striking, that the blows be 
uniform and direct. Again, as the resonance is greater in 
proportion to the solidity of the walls, we direct that the 
patient be placed in such position as will place the muscles in 
a state of tension during the operation. 

The thorax, considered in reference to sound, might be com- 
pared to a drum, the sonorousness of which depends upon the 
vibration of its parchment, and varies with its state of tension, 
and of the medium in which it vibrates. Thus, were the 
parchment thickened by layers of paper or leather fastened 
to it, the note would become deadened; if the drum were 
filled with sponge the same result would ensue ; and if filled 
with sand nothing more than a short, dull noise would be 
given out. The frame of the chest, consisting of thin, flat 
bones, fastened at one extremity by ligaments, and at the 
other by elastic cartilages, and in ordinary cases covered only 
by a moderate layer of muscles, fat, and skin, is favorably 
constructed for resonance on being struck. The cavity, how- 
ever, is not filled with air, like the drum, but with a spongy, 
elastic substance, containing within itself a large quantity of 
air, and therefore offering free motion of its walls. 

In health, the chest when struck emits a hollow sound, 
which varies in different parts of it, and is likewise affected 
by many conditions other than those arising from disease of 
the viscera coutained within. When the walls of the thorax 
are thick, we have less resonance on percussion — as over the 
pectoral muscles, over the clavicle, scapula, etc. The resonance 
is also in proportion to the amount of lung situate beneath 
the part percussed, and is therefore less where the lung is thin, 
as under the false ribs. The resonance of the lower portion 



84 The Eclectic Practice of Medicine. 

of the lungs may also be affected by the abdominal organs 
contiguous to them — the liver on the right side, the stomach 
on the left. Thus, the liver may be enlarged and forced up- 
ward, encroaching on the cavity of the right lung, displacing 
it and giving rise to the symptoms of thoracic disease. In 
this instance, percussion- over the right false ribs would give a 
dull, heavy sound, like that produced in hepatization of the 
lungs. The stomach may be continuously distended with gas 
and displace the left lung; in this case the sound would be reso- 
nant, like that occurring in emphysema, or where a cavity 
exists in the lungs. 

In respect to the contents of the thorax, if the spongy lung 
should be in any part replaced by air, percussion would elicit 
a clearer sound over that spot than over other parts. If it 
should be replaced by solid or fluid matter, the sound would 
be dull in proportion to the solidification. We are thus ena- 
bled to determine by percussion whether the lungs are in 
normal condition as to amount of air contained, or the vari- 
ations of excess and defect. 

Percussion in Disease. — The weight of the frame of the 
chest may be increased in particular spots, by the presence 
of tumors, the products of inflammation, or effusion into the 
cellular tissue ; thus giving rise to increased dullness. A great 
many diseases tend to alter the character of the contents 
of the thorax, some diminishing their density, and others in- 
creasing it. Of the former, are pneumo-thorax — the air 
being between the surfaces of the pleura and emphysema, 
in which the air cells are dilated, and sometimes ruptured, 
whereby the air bears a greater ratio to the lung tissue. 
Again, some diseases destroy portions of the lung, a cavity 
being formed connecting with the bronchial tubes, and filled 
with air. All these diseases produce the same effect in 
respect to percussion, rendering the sound much clearer than 
it is in health, on the principle above stated. The density of 
the contents of the thorax is increased by the presence of 
fluid in the pleural cavities, by distension of the pericar- 
dium, aneurism, and solidification of the lungs. 

In some instances of pleuritic effusion, the fluid is limited 
by adhesions, and the resulting dullness may be confined to 
but one spot of the thorax, but usually it is only bounded by 
the pleural sac. In this case, if in large quantity the whole 
side will be dull on percussion ; but if less fluid exist, the seat 



Auscultation. 85 

of dullness will vary with the position of the body, and will fol- 
low the fluid, which gravitates to the lowest parts. The peri- 
cardium may be distended with blood or serum, displacing the 
lung, or the heart maybe hypertrophied, giving rise to dullness 
over the region of this organ. Yery rarely the pulmonary 
artery or aorta may be dilated so as to reach the surface of 
the chest, or an aneurism may be formed, or a tumor developed 
within the cavity of the thorax. In regard to fluid in the lungs, 
as long as it is confined to the bronchial tubes, the sound of 
the chest on percussion will not be affected, because there is 
plenty of elastic lung between the tubes and the surface of the 
chest. Dullness will, however, result from congestion of the 
cellular portion of the lungs in contact with the walls of the 
thorax, whether of a passive character, being the result of ob- 
struction to the circulation ; or of an active character as in 
the early stage of inflammation ; and also from abscesses or 
excavations containing fluid and approaching the surface. 

Solid matter may also replace the lung, and give rise to 
dullness, — as in strumous or encephaioid disease of the 
mediastinum; tubercles in the lungs; pneumonia, chronic or 
acute, in the stage of hepatization ; pulmonary apoplexy, etc. 
In all these cases the chest will sound dull over the spots 
corresponding tgi these solid deposits. It must be remem- 
bered, however, that a considerable quantity of solid matter 
may exist near the center of the lung, and may also be diffused in 
small masses through healthy lung, as in some cases of acute 
phthisis, without engendering dullness of sound. Percussion 
gives another valuable indication, too generally overlooked, 
i. e., the sensation of resistance in the part percussed, depend- 
ing on increased density in the subjacent lung. When the 
sense of touch is more delicate than that of hearing, this 
source of diagnosis is of great value. In acute phthisis, 
when, from the similar condition of both lungs, there is no 
means of comparison, it is often a most important sign. 

Auscultation. — Auscultation, like percussion, is either 
mediate or direct. By the first, we understand the hearing 
the sounds produced within the thorax, by means of an 
instrument termed a stethoscope; by the second, the listening 
with the unaided ear. Stethoscopes have been made out of 
various materials, and in every form, from a penny whistle to 
a trombone. They are in many cases an egregious humbug, 
interfering with, instead of assisting the object of our investi- 



86 The Eclectic Practice of Medicine. 

gation. The simple wooden cylinder, is undoubtedly the best 
form of stethoscope, and I prefer it without any cavity, — sim- 
ply a round piece of hard wood, adapted to the chest at the 
one extremity, to the ear at the other. The ear, however, is 
the preferable instrument, as it is always present, convenient 
of use, and more reliable than any artificial aid. It is not a 
stethoscope, but the power to concentrate the attention, -and 
call into action that beautiful mechanism that intensifies h ear- 
in^ in the act of listening, that gives success in auscultation. 
This, like everything else, is obtained by patient, persevering 
study, and continued practice. 

In availing himself of auscultation as a means of diagnosis, 
the physician must know the normal sounds produced by 
respiration. By applying the ear to the chest during inspira- 
tion, a soft sound is heard, accurately likened to that pro- 
duced by a person sipping air with his lips. Sometimes this 
sound is prolonged so as to accompany the escape of air from 
the chest; always, however in healthy persons being less 
intense in expiration than in inspiration. This is called the 
vesicular or respiratory murmur, or pulmonary respiration. 
At certain parts of the chest, over the large bronchial tubes, 
as between the scapula, the sound during inspiration is coarse 
and blowing; this is called the bronchial respiration or 
sound. Over the trachea the sounds are much stronger than 
those heard over any part of the chest; they are nearly, if 
not quite equal in duration and intensity, both in inspiration 
and expiration. They possess a peculiar, hollow, blowing 
eh araeter, as if wind was blown from a tube into the ear ; 
this is called the tracheal sound. 

When the ear is placed over the trachea, or between the 
shoulder blades of a person in the act of speaking, the 
voice appears to issue from the spot to which the ear is 
applied. This resonance of the voice is called broncophony. 
In other parts of the chest no resonance of the voice is 
perceptible. 

The sounds heard in auscultation of the lungs in disease, are 
modifications of the natural respiratory murmurs, and adven- 
titious rounds which supersede them, called rhonci. Natural 
respiration may be variously altered; sometimes the pulmon- 
ary sound is increased above its normal standard, at others it 
is diminished or disappears entirely. The intensity with 
which sound reaches the surface of the chest may depend 



Auscultation. 87 

either upon its formation or its propagation. Increased inten- 
sity of the respiratory murmur may occur in the parts of the 
lung adjoining those rendered unfit for the purposes of respi- 
ration, the sound parts of the lung receiving air in greater 
quantity to make up for the deficit caused by want of action 
in the diseased part. Thus, it will be found that when the 
whole, or a large part of one lung is rendered impervious to 
air by disease, the intensity of the respiratory murmur will, 
in nearly all cases, be increased in the opposite lung ; this has 
been termed puerile respiration, as the sound is much more 
intense in children than in adults. 

Decreased intensity or entire suspension of the respiratory 
murmur, may take place by the deposit of solid or liquid mat- 
ter in the air cells, minute bronchial tubes, or intercellular 
tissue, whereby the expansion of the lung and the passage 
of the air through the minute tubes in which this sound is 
generated is prevented. This occurs in pneumonia, pulmonary 
apoplexy, and phthisis. It may also take place from any ob- 
struction which prevents the air from entering the bronchial 
tubes; as from accumulations of mucus, pressure caused by 
diseased bronchial glands, aneurism of the aorta, etc. The 
intensity may also be affected by the medium through which 
it is propagated ; thus, the sound will vary in intensity accord- 
ing as the thoracic walls are thin or loaded with fat, serum in 
the cellular tissue, lymph on the pleural surface, or tumors of 
various kinds. It will also be deadened if the lung be sepa- 
rated from the thoracic wall by effusion in the pleural cavities; 
in this case the sound will be impaired both in its formation 
and propagation. 

Respiration is sometimes incomplete, the respiratory mur- 
mur being deficient at its beginning or close ; this accompa- 
nies spasmodic asthma, or whenever there is spasm of the 
bronchial tubes. It may also be jerking, having two or three 
interruptions during each inspiration ; this is met with in 
asthma, incipient pleurisy, and certain cases of tuberculous 
infiltration. The respiratory murmur is a smooth, even, musi- 
cal sound, when the lungs are in a healthy condition. It be- 
comes rough and harsh in its character in certain diseases, 
and is then a very important sign ; thus, in the first stages of 
phthisis, it is sometimes the only certain and available symp- 
tom of the affection. 

When the bronchial sound is heard over any portion of the 



88 The Eclectic Practice of Medicine. 

chest other than between the scapula, and over the top of the 
sternum, it arises from condensation of the pulmonary tissue; 
this occurs in pneumonia, tuberculosis, etc. 

The adventitious sounds are those that either mask or sus- 
pend the natural sounds. They are caused by alteration in 
the caliber of the bronchial tubes, or by air bubbling through 
fluid contained in these tubes, or in cavities of the lungs. 
These sounds are either dry or moist, and may be classed as 
follows : 

f Sibilant. 
Dry. •{ Sonorous. 

[ Dry Crackling. 

' Crepitant. 

Moist. J ^-Crepitant. 
I Mucous. 
(^ Cavernous. 

The sibilant and sonorous rhonci are heard in cases where 
the bronchial tubes are diminished in caliber, accompanied 
with dryness of the mucous membrane, as in the early stage 
of bronchitis; the sibilant rhoncus being produced in the 
small tubes, the sonorous in the large. 

The dry-crackling rhoncus is composed of a succession of 
minute, dry, short, sharp, crackling sounds, few in number, 
rarely exceeding three or four, coexisting with inspiration. 
It is heard in the first stage of phthisis, and is indicative of 
unsoftened tubercle in moderate quantity. 

In bronchitis, in the first and second stages of pneumonia, 
in certains forms of pulmonary congestion, and sometimes 
where there are cavities formed within the lungs, the air pas- 
sages contain fluid of various degrees of consistence. In 
passing through this fluid the air forms bubbles, which burst- 
ing give rise to moist rattles, the sound of which varies with 
the size of the tubes or cavities in which they are formed. 

Of these moist rhonci the crepitant and sub- crepitant are 
formed in the smallest bronchial tubes and in the intercellular 
passages. The crepitant rhoncus resembles the sound pro- 
duced by rubbing a lock of hair between the fingers near the 
ear, and is the physical sign of pneumonia in the stage of 
engorgement and resolution. In the sub-crepitant rhoncus 
the sound is more moist, and gives the idea of a greater amount 
of liquid ; it occurs in capillary bronchitis, idiopathic and 



Auscultation. 89 

tubercular, in pneumonia at the period of resolution, pulmonary 
apoplexy, and oedema of the lungs. 

When the sound is produced in the larger bronchial tubes, 
it is called the mucous rhoncus. This sound is heard both dur- 
ing inspiration and expiration, and the larger the tube the 
louder the sound, and the more ringing its quality. This is 
heard when there is increased generation of sound, as in 
bronchial diseases ; or when the lung is rendered a better con- 
ductor of sound, as in solidification of the lungs from various 
causes. Thus, it is heard in acute bronchitis, when secretion 
is established, in chronic bronchitis, asthma, etc. ; and in the 
second case in pneumonia, tuberculosis, etc. In some cases of 
great debility a large quantity of mucus often accumulates in 
the air passages from want of power to expectorate, giving 
rise to the mucous rattle. This sound takes the name of the 
tracheal rattle when it is very loud and ringing, and very pro- 
perly so, as it is produced in the trachea. In some cases of 
chronic bronchitis the mucus is very thick and tenacious, 
which gives rise to a succession of large cracklings, as if large 
bubbles were slowly formed and burst ; this is more marked 
when the current of air is feeble, as in emphysema of the 
lungs. 

The cavernous rhoncus has a peculiar hollow and metallic 
sound, varying with the size of the cavity, with the quantity 
of fluid it contains, and with the density of its walls. If the 
cavity be small, it will resemble the mucus rhoncus, if the cav- 
ity be large the sound will be proportionate to its size. In 
cases in which the cavity has cicatrized, no fluid being con- 
tained, the sound will resemble that produced by blowing in a 
bottle, and is termed the amphoric sound. 

On the application of the ear to the healthy chest when a 
person is speaking, a diffused buzzing is heard, except over 
the upper part of the sternum, over the larger bronchial tubes 
and trachea, between the scapula, where the voice is trans- 
mitted with some force, constituting natural broncophony. In 
disease several modifications of vocal resonance occur. It 
may be diminished in intensity, or be entirely suppressed, from 
the feeble conducting power of the substance of the lung, or 
intermediate substance, as we observe in vesicular emphysema 
and pneumo-thorax. Or it may be exaggerated broncophony. 
This exists whenever there is an unusual density of the pulmo- 
nary tissue situate between a bronchial tube and the wall of 



90 The Eclectic Practice of Medicine. 

the thorax, rendering it a better conductor of sound. This 
happens in tuberculous solidification, and in the stage of hepa- 
tization in pneumonia. 

By pectoriloquy we understand a state of vocal resonance, in 
which the voice appears to resound in a hollow space, and is 
transmitted as articulate words to the ear of the observer. 
The presence of an excavation or dilated bronchus, whose con- 
dition permits free vibration is necessary for its production, 
and it is present, therefore, in tubercular caverns, and dilated 
bronchi. In conditions of the lung favorable to the produc- 
tion of broncophony, if there be effusion of fluid within the 
pleura, a tremulous, nasal and metallic tone resembling the 
bleating of a goat, will be heard. This is termed cegophony, 
and is audible over but a limited surface, and its position may 
alter with the position of the patient. 



CORYZA. 

Symptoms. — This is simple, sub-acute inflammatio of the 
mucous membrane of the nares, the result of cold; it may 
exist alone, or in connection with disease of more or less of 
the other respiratory passages. It commences with a " stuffing 
up of the head " with dull, heavy pain or aching, a feeling of 
dullness and debility, and sometimes pain in various parts of 
the body. In a day or two there is copious secretion from the 
nose; the secretions are arrested to some extent, there being 
dryness of the skin, constipation of the bowels, and scanty 
urine. It is a common form of bad cold. * 

Treatment. — Though not dangerous, yet it is extremely 
annoying, and lasting from one to three weeks, it seems desir- 
able to get rid of it at the commencement. This is accom- 
plished by restoring the secretions ; thus, if we have our patient's 
feet bathed in mustard and water, or in severe cases use the 
spirit vapor bath, and freely administer some warm, stimulat- 
ing diaphoretic infusion, we accomplish the purpose. Or, if 
it is preferred, the wet-sheet pack will answer the same pur- 
pose. Or if there is derangement of the stomach, a most 
speedy, and efficient treatment is a thorough emetic. A brisk 
cathartic answers the purpose in some cases, and a solution of 
Acetate of Potassa to the amount of two or three drachms per 
day, with a small portion of Tincture of Gelseminum is very 
efficient. The last remedy is one of the most efficient of all 



Influenza. 91 



agents, when the patient feels the first sensation of cold, 3ss« 
taken, with an hour or two's sleep is almost a specific. 



INFLUENZA. 

EPIDEMIC CATARRH. 

This disease has occurred as an epidemic many times in the 
history of medicine, and several times in this country. As 
regards its cause, we are entirely in the dark ; it being sup- 
posed by some, that it was produced by long prevailing east- 
erly or northerly winds — extremely variable and damp weather 
— upon telluric influences — upon contagion — upon alterations 
of the electricity of the air, etc. Thus, Copland remarks, that, 
" the seasons and the state of the weather, both antecedently 
and at the time of the outbreak of influenza, have had no share 
in its production. Whether appearing in spring, summer, 
autumn, or winter ; or occurring in mild and dry, or in cold 
and moist weather ; or prevailing in cold, temperate, or warm 
countries, it has presented the same general features. ,, 

Symptoms. — The disease usually commences with a well 
marked chill lasting for two, three, or four hours, followed by 
heat of skin, coryza, sneezing, fullness and tenderness of the 
eyes, soreness of the throat, hoarseness, cough, pain in the 
back and limbs, restlessness, and marked fever. The cough 
for the first day or two is usually dry, and attended with 
some soreness of the chest, slight dyspnoea, and hurried respi- 
ration ; afterwards expectoration becomes abundant and easy, 
nausea, loss of appetite, vomiting, costiveness, with a white 
appearance of the tongue, are generally present. About the 
fourth or fifth day the symptoms become mitigated, secretion 
being established from the skin and kidneys; but the cough 
frequently continues, being severe and obstinate. 

" The complications, or prominent affections of influenza, 
were chiefly, a peculiar inflammatory condition of the throat 
and pharynx — severe gastric disorder — bronchitis — a spe- 
cific pneumonia, or pleuro-pneumonia — tubercular phthisis — 
a form of pleuritis — rheumatism — disease of the heart and 
pericardium, — and severe adynamic and nervous fever/' 
(Copland). These complications gave the disease in many 
cases a degree of fatality, which would not have attended the 
simple affection. 



92 The Eclectic Practice op Medicine. 

Treatment. — The treatment of this disease should be very 
similar to that proper for fevers arising from cold. Diapho- 
retics have been strongly recommended ; thus, the patient's feet 
should be thoroughly bathed in mustard water, strong stimu- 
lant applications applied to the spine, packed warmly in bed, 
and given the Compound Tincture of Virginia Snake-root in 
teaspoonful doses every two hours. The spirit vapor bath 
has been used with much advantage, as has also a thorough 
and prompt emetic. The common treatment for fever may 
also be employed; give first the special sedatives in small 
doses, frequently repeated ; use the hot foot bath and as soon 
as the pulse is reduced, give diaphoretics and diuretics. Ca- 
thartics should be avoided, a simple laxative being employed 
if the bowels are bound up. Dr. Christison strongly recom- 
mended Opium in full doses, with a sparing diet. Eupatorium 
Perfoliatum has been successfully employed ; " in the severest 
cases the disease was treated with this alone, the patient being 
warmly covered in bed, was induced to swallow a wineglassful 
of the infusion, warm, every half hour. After the fourth or 
fifth dose, considerable nausea, sometimes vomiting, with free 
diaphoresis, ensued, and there was an amelioration of all the 
symptoms.'' 



OZJE^A. 

By ozsena we understand a chronic, foetid discharge from 
the nares, which may be simply a chronic inflammation of the 
mucous membrane (ozaena benigna), or dependent on caries 
of the bones. The cause of the disease is generally a neglect- 
ed catarrh, though sometimes it is of syphilitic origin. The 
disease affects various parts of the cavity of the nose, some- 
times extending to the frontal sinus; and even to the 
ethmoidal and sphenoidal cells. Again, it is confined to but a 
small surface, which is ulcerated, and sometimes the bone 
beneath is diseased. 

Symptoms. — In chronic inflammation of the mucous mem- 
brane of the nares, the patient complains of uneasy sensations, 
with frequent stuffing up of the nose, nasal voice, and a con- 
stant offensive discharge. In cases in which the upper part of 
the nares, and the frontal sinus is affected, it frequently gives 
rise to persistent headache, the pain being in the anterior part 



Chronic Pharyngitis. 93 

of the head. In cases of caries of the bones the discharge 
has that peculiar odor that always attends the breaking down 
of bone, and very frequently an examination determines the 
circumscribed locality of the disease. 

Treatment. — For the chronic inflammation we employ a 
variety of agents in the form of inhalation, injection or snuff. 
An inhalation of Acetous Tincture of Sanguinaria, or that of 
Myrrh, of the vapor of Creosote, ten drops being dropped 
into a basin of hot water, the patient breathing the vapor, or 
of Balsam Tolu or Peru, the vapor being drawn into the 
mouth and passed out through the nose, answers a very good 
purpose. In some cases we find it better to use remedies by 
injection; commencing first with simple w T arm water to thor- 
oughly cleanse the nose of the decomposing mucus ; we follow 
with such medicated injections as seem demanded, as the 
Chlorate of Lime, Sesquicarbonate of Potassa, Nitrate of Sil- 
ver, Dilute Pyroligneous Acid, etc. The syringe used for 
this purpose should be the long silver tube closed at the 
extremity, and perforated at the sides with numerous minute 
holes. In many cases a combination of, #, Podophyllin, gr. v ; 
Sesquicarbonate of Potassa, gr. xv. ; Sanguinarina, gr. ij. ; 
Hydrastine, gr. x; Ulmus Fulva, 3i; finely pulverized, answers 
an admirable purpose as a snuff, used two or three times a 
day. The quantities named are but the average proportions, 
and will have to be changed to meet each individual case. 

If there is disease of the bones, within reach, as of the 
turbinated bones, vomer, or anterior portions of the superior 
maxillary, the same local applications that would be indicated 
in caries of other parts, will be useful here. The Sesqui- 
carbonate of Potassa in powder or solution, and the Chloride 
of Zinc, are my favorite agents, the latter being used in a weak 
solution, say from gr. ij to gr. x to the ounce of Water. In 
many of these cases a strictly tonic general treatment will have 
to be pursued, and as the patient's health improves, we notice 
improvement of the local disease. 



CHRONIC PHARYNGITIS. 

We notice this here, as it is so frequently associated with 
disease of the posterior nares, and as a general rule precedes 
chronic laryngitis. The patient complains of a frequent sense 



94 The Eclectic Practice of Medicine. 

of " stuffing up " in the back and upper parts of the throat, 
which gives rise to a hawking and spitting up of a considera- 
ble amount of mucus. As it continues there is manifested a 
tendency to cough, which at last becomes confirmed, the 
disease having extended to the larynx. On examination we 
find the mucous membrane thickened, and laid together in 
folds, or looking relaxed and flabby, the mucous follicles en- 
larged, and the color changed from the smooth pink to a 
dusky red, livid or bluish-blanched appearance. 

Treatment. — We treat this affection by local applications 
adapted to the condition of the mucous membrane. A gargle 
of Hydrastis Canadensis, 5j; Tincture of Myrrh, 3'ij ; Aqua, 
5xiij : Mix; or, #. Tincture of Capsicum, f3ij ; Tannic Acid, 
Geranine, aa3ss; Aqua, Oj : Mix; or, a decoction of the Cor- 
nus Florida, or this and the Quercus Rubra, or the Marsh Rose- 
mary are very efficient agents. The Nitrate of Silver, in solution 
of 3ss to 3j ; Water, 3j, may be used in some cases as a stimulant, 
and should be applied with a probang. If there are any symp- 
toms of the disease extending downward to the larynx, con- 
tinuous counter-irritation to the sides of the throat should be 
immediately adopted. 



DIPHTHERIA. 

Much has been written about this, the latest epidemic of our 
country, and the majority have adopted the opinions I ex- 
pressed in regard to it in the Eclectic Medical Journal of June, 
1861. I hold diphtheria to be a general as well as a local dis- 
ease, as is proven by the languor, listlessness, torpor of the ner- 
vous system, and derangement of the excretory organs, which, as 
a general rule, precede the local disease; all being symptoms 
of perversion of the blood, and almost invariably indicating 
the establishment of febrile reaction. We also find the evi- 
dence of perversion of the blood, in the heavily-coated tongue, 
which is more or less discolored at the commencement of the 
disease, and always, in severe cases, exhibiting the brownish 
tinge, with more & less sordes upon the teeth as the disease 
progresses ; in the diphtheritic deposit, which is markedly dif- 
ferent from the exudations from highly vitalized blood ; in the 
secretions, the urine, in severe cases, being abundant, in all 
cases discolored, frothy, more or less clouded, with a peculiar, 
somewhat cadaverous odor — what the ancients would have 



Diphtheria. 95 

termed illy concocted; in the evacuations from the bowels, ob- 
tained by cathartics, which are frequently large, dark, and 
almost invariably foetid ; and especially in the condition of the 
blood itself, when the disease has attained its maximum, which 
is dark, is not changed by exposure to air, forms a loose, easily 
broken-down coagulum, or does not coagulate at all. Post- 
mortem examination, in those cases that have run a regular 
course, i. e. y that have not been terminated by an extension of 
the disease to the respiratory apparatus, shows us the blood 
broken down to considerable extent, more or less discoloration 
of tissues from extravasation of the coloring matter and soft- 
ening of the tissues. These facts, it appears to me, prove con- 
clusively the opinion given above. 

There are cases in which the disease is entirely local, at 
least there is no febrile reaction ; but such cases are mild. In 
all severe cases there is fever, which sooner or later assumes a 
typhoid type. In order to get a fair understanding of the case 
then, let us divide the disease into, first, a fever of an ady- 
namic character; and second, a local inflammation of the mu- 
cous membrane of the throat. 

Symptoms. — Usually diphtheria commences with a slightly- 
marked chill, lasting from two to six hours; though sometimes 
it is quite severe. Following this, febrile reaction comes up; 
sometimes slowly and not very well marked, at others quite 
acute. A very marked feature in this affection, in a majority 
of cases, is the slow development of the fever and its want of 
intensity for the first two or three days. About the fourth 
day of the disease, if not modified by medicines, the fever has 
assumed a marked adynamic character; the pulse is feeble, 
soft, and easily compressed, or small and hard; there is 
marked stupor of the nervous system; pungent heat of the 
surface, with dry and husky skin; tongue dry and covered 
with brownish fur, and entire loss of appetite. Subsequently 
the fever runs the course of a common typhoid fever, unless 
life is terminated by the disease of the throat extending to the 
respiratory passages. 

At the commencement the patient complains of sore throat, 
difficult deglutition, and some difficulty of breathing. On ex- 
amination, we find more or less tumefaction of the mucous 
membrane of the fauces, tonsils, and pharynx ; sometimes of 
a bright red color, at others dusky or livid, and at others 
blanched. Upon some of these parts we find the peculiar exu* 



96 The Eclectic Practice of Medicine. 

dation characteristic of the disease, in the shape of patches of 
an ashen-grey lymph, situate on the surface of the mucous 
membrane. As the disease progresses this exudation spreads, 
forming large patches, and sometimes covering all the mucous 
membrane visible, extending up to the nares and downward to 
the pharynx. By the fourth or fifth day portions of this be- 
come detached and are thrown oif, leaving a foul secreting ulcer ; 
there is also a secretion of muco-pus, altogether forming a 
very unpleasant, foetid discharge in large quantity. Occasion- 
ally the affection of the nares is such that respiration through 
them ceases; and, again, the muscles of deglutition are so 
paralyzed that if the patient attempts to swallow, the ingesta 
is returned through the nose, giving rise sometimes to immi- 
nent danger of suffocation. If the disease extends to the 
larynx, pseudo-membranous croup is the result, presenting all 
its characteristic symptoms and attended with its danger. 

Diagnosis. — Diphtheria is easily diagnosed by the soreness of 
throat, the peculiar exudation, and marked prostration of 
strength. 

Prognosis. — Though considered an exceedingly fatal disease, 
and giving a large per centage of deaths in reports of the epi- 
demic, I do not from my experience consider the prognosis 
unfavorable if proper treatment is given at the commence- 
ment of the disease. If, however, it progresses to the fourth 
or fifth day, the patient being prostrate and the local disease 
very extensive, the prognosis is doubtful. 

Treatment. — What are the indications of treatment in 
such a fever? Plainly they are; first, to reduce the rapidity 
of the circulation, because we well know that the change in 
the blood, spoken of above, progresses much slower when the 
frequency of the pulse is reduced ; innervation is improved, 
and the system placed in such condition that we can get an 
action from the excretory organs ; second, to get secretion from 
the skin, kidneys, and bowels, as it is through these organs 
that the morbid material circulating in the blood must be 
eliminated ; third, to increase innervation, for reasons that 
must be obvious to the reader; fourth, to employ such anti- 
septic agents as will counteract the septic tendency of the 
blood; and fifth, to sustain the strength of the patient. 

To fulfill the first indication, we may employ either the 
direct or indirect sedatives. I prefer the first, and select Tinc- 
ture of Veratrum and Aconite as the agents. They must be 



Diphtheria. 97 

properly administered, however, as they are agents that can 
saot be given at random without danger. To Water, gvj, add 
Tincture of Veratrum Yiride, Bij ; Tincture of Aconite Root, 
gtt. xxx ; Concentrated Tincture of Asclepias, 3ij ; to a child 
five or six years old give a teaspoonful every hour, until the 
pulse is reduced to about ninety beats per minute, continuing 
the remedy in such doses as will just retain it at that point. 
Usually, from six to ten hours will elapse before you have pro- 
duced^ the necessary sedation; in the meantime the alkaline 
bath may be used, or, if there is deficient circulation to the 
skin, add stimulants ; the extremities must be kept warm. It 
has been objected to the use of sedatives in this disease, that 
they produce prostration ; and so they will if given in large 
doses undiluted; but, in the way I recommend, I guarantee 
;hat the pulse becomes stronger, with better circulation in the 
extremities, and better innervation as sedation is produced. 

One thing at a time is the golden rule in medicine; we ful- 
fill the first indication before trying to fulfill the second, for 
the very good reason that until we have reduced the rapidity 
of the circulation it is impossible to get secretion. Almost 
any warm diaphoretic infusion will now cause secretion from 
the skin ; to the diaphoretic add Acetate of Potassa, so that 
the patient will take about 3j in twenty-four hours; or, if the 
disease has progressed, until antiseptics are needed. Chlorate 
of Potassa should be substituted for it, adding an equal quan* 
tity of Muriate of Ammonia. If symptoms exist indicatino- 
the necessity of evacuating the bowels, accomplish it with 
mild vegetable cathartics ; if not, let the bowels alone. 

As soon as secretion from the skin and kidneys is estab- 
lished, we commence the administration of Quinia, with some 
suitable bitter tonic, say Hydrastine. The principal object in 
giving Quinia is to obtain better innervation; which is the 
invariable result, when the system is properly prepared for its 
administration, and it is rightly given. We would combine 
the agents named, in equal parts, giving from one to two grains 
every three or four hours. If the remedy causes excitation 
of the brain, with increased frequency of the pulse, stop it 
until these symptoms pass off, then recommence with smaller 
doses; if it fails to accomplish the end desired, increase the 
doses, recollecting that we continue the three different classes of 
remedies together, for the purpose of continuing the influence 
of each. 

7 



98 The Eclectic Practice of Medicine. 

The fourth indication, it will be seen, is being fulfilled by 
the agents named above; but, if our patient desires acid 
drinks duriug any period of the disease, they should be given. 
The fifth indication is also being fulfilled; but as soon as the 
fever is reduced, and secretion established, nutritious food 
should be given in such quantities as can be digested by the 
patient. If at any period of the disease prostration becomes 
such that they are demanded, we use stimulants — as we would 
in the latter stages of typhoid fever. There is one thing yet 
to be mentioned: 

Our patient must have sleep; it will not answer to give nar- 
cotics, while there is febrile reaction and want of secretion; 
but as soon as the two first indications are fulfilled, we can 
use Opium for the induction of the necessary rest, with the 
greatest advantage. 

I have been thus explicit, in the direction of the general 
treatment, because it is of major importance; the constitu- 
tional or general disease must be arrested if we wish to con- 
tend successfully with the local affection. Please observe that 
I give medicine by rule, and try to accomplish one thing at a 
time. 

Upon examination of the throat, in the early stage of the 
disease, we find two distinct conditions: in the one case the 
mucous membrane is bright red ; in the other, of a dark pur- 
plish color, or somewhat blanched, with bluish discoloration. 
In the first instance, I apply with probang, Tincture of Vera- 
trum, just sufficient to wet the surface, which exerts a marked 
i niiuence in arresting inflammation. In both cases I direct, as 
a gargle, Chlorate of Potassa, 3ss; Water, 3iv; to be used 
every one, two, or three hours. Where there is dark discol- 
oration, I add 3 j vel, ij of Tincture of Myrrh. The exter- 
nal application, invariably, is a flannel cloth, folded three or 
four thicknesses, wrung out of cold Vinegar, to be changed 
every two or three hours, and constantly kept covered by a 
dry flannel. If there is much tumefaction of the mucous 
membrane, dry-cup the neck; or, if nothing contra-indicates 
and the case demands it, cup and scarify. We wish to keep 
the throat as free from the exudation as possible, in order to 
prevent serious ulceration, which sometimes assumes a pha- 
gedenic character; when, therefore, it becomes partially de- 
tached, remove it. 

If there is an extension of the disease to the larynx, mani- 



Cynanche Maligna. 99 

fested by stridulous respiration, croupy cough, altered, and at 
last, loss of voice, give an emetic of Acetous Tincture of 
Lobelia and Sanguinaria, or, if there is greatly increased 
secretion, with difficult evacuation, so as to clog up the air 
passages, and produce symptoms of slow asphyxia, give the 
emetic; or, if there is alarming prostration of strength at the 
commencement of the disease, give the emetic; or, if the dis- 
ease commences with nausea or vomiting, give the emetic. 



CYKAJTOHE MALIGNA. 

MALIGNANT SORE THROAT. 

I consider this disease here, not as one that affects the air 
passages specially, but as bearing a strong resemblance to the 
preceding in its constitutional symptoms. The cause of the dis- 
ease is not well known, audit generally prevails as an epidemic 
or is endemic, and is undoubted^ infectious in the severer cases. 

Symptoms. — It is usually preceded by symptoms of prostra- 
tion, listlessness, languor, loss of appetite, disordered secre- 
tions, loaded tongue, and foul breath. Following these, we 
have soreness of the throat rapidly increasing, so that soon 
the patient swallows with the greatest difficulty, can hardly 
articulate, and if the nares are involved has labored respira- 
tion, low, we observe that the pulse is frequent, soft, iiuent, 
and easily compressed, the bowels irregular, urine frothy and 
markedly foetid, skin dry, parched, and rough, or relaxed and 
flabby, with clammy perspiration; the countenance appears 
pinched and sallow, the lips dusky and dry, the mouth filled 
with the secretion from the throat and the exceedingly tena- 
cious and stringy saliva. 

If we examine the throat at the commencement we will find 
the mucous membrane swollen, and of a dusky red or livid 
color, or in some cases pale, relaxed, and oedernatous. In a 
couple of days we observe that patches of epithelium have been 
thrown off, leaving a superficial ulcer secreting a foetid muco- 
pus: these ulcers spread until a large part of the throat is 
involved, or increase in depth, at times assuming a phagedenic 
character, rapidly destroying the tissues. 

Diagnosis. — We diagnose this disease by the soreness of the 
throat, attended with general prostration, deranged secre- 
tion, and the fcetor of the breath and secretions from the 
throat 



100 The Eclectic Practice of Medicine. 

Prognosis. — The prognosis is favorable at the commence- 
ment of the disease in persons of good constitution ; but 
even then it will sometimes continue for a period of ten 
or fifteen days, and leave a relaxed atonic condition of the 
throat that the patient does not entirely recover from for 
months. 

Treatment. — The treatment must be both general and 
local. A saturated solution of Chlorate of Potassa given in 
teaspoonful-closes every hour, with a stimulant diaphoretic 
infusion, as of Pennyroyal, Spearmint, Sassafras, etc., with a 
o-eneral stimulant bath of dilute Tincture of Capsicum will be 
appropriate. We find less arrest of secretion in the forenoon, 
and this is the best time to administer Quinia, which becomes 
a very important part of the treatment: #, Quinia Sulphas, 
Hydrastine, aa, gr. x; mix, and divide into three powders, 
of which one should be taken every three hours. Counter- 
irritation to the spine and neck with some stimulant liniment 
is important. 

For the throat we direct stimulant inhalations, as of Pyro- 
ligneous Acid, Tar, Creosote, Acetous Tincture of Sanguin- 
aria, etc. As a gargle the solution of Chlorate of Potassa can 
be used frequently; or what is better: #, Solution of Chlori- 
nated Soda, f3ij; Water, 3x; mix; to be used frequently and 
freely. This removes the foetid secretion, and should be fol- 
lowed by a gargle of a strong infusion of Cinchona, or Bay- 
berry and Geranium, or Cornus and Red-Oak Bark; to these 
the Tincture of Myrrh may be added, if there is a necessity 
for farther stimulation. The local applications recommended 
iu diphtheria will be appropriate here. 



TONSILLITIS. 

QUINSY. 

The tonsils in some persons appear to be predisposed to 
inflammation, and from the action of cold upon the system 
and atmospheric vicissitudes, they suffer frequently and severely 
from this affection. The predisposition to return is the worst 
feature of the disease, and the most difficult to remove. Both 
tonsils are usually affected at once, or in succession, but some- 
times the disease is confined to one. 

Symptoms. — Quinsy usually manifests itself first, by soreness 



Tonsillitis. 101 

and stiffness of the throat, with difficult deglutition, and more 
or less derangement of the digestive functions : occasionally it- 
is ushered in with a marked chill, followed by febrile reaction. 
There is always some fever, dryness and constriction of the 
skin, and general arrest of secretion. In a few hours, the 
patient complains of pain, and a sensation as if some foreign 
body were present in the throat, with heat and constant desire 
to swallow. "When fully developed, deglutition becomes so 
difficult and painful as to occasion extreme suffering, and in 
some cases it is impossible. A guttural cough, with frequent 
desire to remove the secretion from the throat; a hoarse and 
difficult respiration, and confused whispering, and guttural 
articulation, or sometimes entire loss of voice is observed. In 
the severer cases it becomes impossible for the patient to lie 
down, and in many, but little rest is obtained in consequence 
of the difficult respiration when the will is in abeyance. If 
we examine the throat in this disease, we will find the tonsils 
enlarged, and reddened ; sometimes so large as to entirely close 
the opening of the fauces. 

An attack of quinsy continues for a variable length of time : 
usually from four to twenty days, and terminates sometimes 
by resolution, at others by suppuration. "When it terminates 
the last way, the gland rapidly enlarges ; there is a dull throbbing 
pain or aching, and a yellowish color near where the pus 
points ; usually it readily comes to the surface and discharges 
without assistance, but sometimes it is very slow and requires 
the lancet. 

A condition of chronic inflammation and enlargement fre- 
quently continues, in those predisposed to the disease. The 
glands appear prominent on examination ; the mucous follicles 
enlarged ; the color a dusky-red, and considerable tenderness. 
Associated with this, we frequently have a chronic irritation 
with determination of blood to the entire isthmus of the fauces, 
and elongation of the uvula, srivinff rise to a continuous dis- 
agreeable cough, derangement of the general health, finally 
inducing serious disease of the respiratory apparatus. 

Treatment. — In the first stage of the disease, we direct the 
hot foot bath with the free use of a nauseant diaphoretic, as 
the Eupatorium, small doses of Lobelia with infusion of Pen- 
nyroyal, Sage, etc. At the same time the patient should inhale 
frequently, the vapor of Vinegar and Water, of Camphor and 
Vinegar, or of equal parts of Vinegar and Water holding in 



102 The Eclectic Practice of Medicine. 

solution a considerable portion of Nitrate of Potassa. As a 
local application to the throat, the Tincture of Veratrum, 
applied with a probang, two or three times daily, or oftener, is 
the most efficient remedy I have ever used during the first 
day or two. Gargles are not very serviceable in this stage of 
the disease, but the throat may be cleansed with dilute Vine- 
gar, Solution of Nitrate of Potassa, or Muriate of Ammonia 
and Mucilage. Warm fomentations are very frequently 
resorted to, but without favorable results : I prefer the simple 
cold Vinegar pack, or the application of a cold Terebinthi- 
nate embrocation. A brisk cathartic in the early stage, is 
often of benefit, and occasionally it is necessary to repeat it. 

In the asthenic forms of the disease, occurring in persons of 
feeble health, or in those in which the structures have been 
permanently impaired by its frequent recurrence, a stimulant 
and astringent local treatment is better. Thus, we direct a 
gargle of Alum, of solution of Tannic Acid and Capsicum, as 
heretofore named, strong Tar Water, Pyroligneous Acid, Sul- 
phate of Zinc, etc. In these cases inhalations of Camphor, 
Myrrh, Pyroligneous Acid, Tar, etc., with Vinegar, will be 
found useful. Here we find the cups to be the best external 
application, followed by warm fomentations of Lobelia, 
Hops, etc. 

If the disease continues, after sufficient time has elapsed to 
produce resolution, it is better to resort to warm fomenta- 
tions or poultices, with the internal use of demulcents to 
favor suppuration. If the patient suffers greatly, and a suffi- 
cient length of time has elapsed for the pus to have fyeen dis- 
charged, we open the abscess with a scalpel guarded and 
passed directly backwards. All that is necessary then being 
the employment of astringent and stimulant gargles. 

In the chronic enlargement that follows the acute disease, 
we can sometimes succeed in removing the irritation and 
hypertrophy by the judicious use of stimulant and astringent 
applications. I have used with marked advantage- the Per- 
sulphate of Iron, both dry and in solution. The Nitrate of 
Silver has been used with benefit, but is far inferior to the 
agent just named. In addition I direct a gargle of Bayberry, 
Yellow Dock, and Red Oak Bark, or a direct application on 
cotton of finely-powdered Sanguinaria, moistened with Vinegar 
for half an hour to one hour, daily. These means, associated 
with the external employment of the irritating plaster, will 



Acute Laryngitis. 103 

prove successful in many cases, entirely removing the predis- 
position to quinsy. In other cases no means will prove suc- 
cessful, unless the tonsils are excised; and even this fails 
frequently. 



ACUTE LARYNGITIS. 

This disease may properly be divided into three forms: 1st, 
catarrhal laryngitis; 2d, acute laryngitis proper; and 3d, asthe- 
nic laryngitis. It occurs as a simple inflammation, confined 
strictly to the larynx, or associated with disease of other parts 
of the respiratory apparatus. The cause of laryngitis is gen- 
erally cold and sudden atmospheric changes, though it may 
be produced by the inhalation of irritant vapors, etc. 

Symptoms. — 1st. In catarrhal laryngitis the disease is usually 
associated with catarrh, and characterized by the usual catar- 
rhal symptoms. In addition, the patient complains of con- 
striction and soreness of the larynx, hoarseness or partial loss 
of voice, which sinks to a whisper, and a hoarse cough, which 
is at first dry, but is attended with expectoration, as the dis- 
ease progresses. 

2d. Acute laryngitis proper is a most dangerous form of dis- 
ease. It usually commences with a slight chill, soreness and 
stiffness of the throat, difficulty of swallowing, and sense of 
constriction and desire to clear the throat. Following the 
chill, febrile reaction comes up, and is quite intense, consider- 
ing the extent of the inflammation. Then a dull pain is felt 
in the throat, the sense of constriction is markedly increased, 
and there is tenderness on pressure; the voice is harsh, hoarse, 
or stridulous, and there is a frequent dry short cough. If the 
throat is now examined, the fauces will be found red and 
tumid, and when the tongue is pressed down the epiglottis 
may be seen erect, swollen, and red. In the course of from 
twelve to twenty hours, the inflammation has markedly dimin- 
ished the aperture of the glottis, the voice becomes small, pip- 
ing, whispering, and soon suppressed. The breathing is diffi- 
cult, inspiration being sibilous, shrill, prolonged and laborious, 
the larynx being forcibly drawn down on each attempt to 
inflate the lungs. The cough is stridulous and convulsive, 
and attended by attacks of spasm of the glottis, which threat- 
ens suffocation, the expectoration being scanty and viscid, and 
removed with difficulty. In the last stage of the disease, the 



104 The Eclectic Practice of Medicine. 

patient exerts all his power in respiration, sitting upright and 
grasping objects in reach to bring into play the external 
inspiratory muscles. The countenance is pale and anxious, 
the lips livid, and the eyes almost start from their sockets, the 
extremities are cold, and covered with a clammy perspiration. 
Soon a low delirium or coma comes on, the pulse becomes 
more feeble and intermittent, imminent symptoms of asphyxia 
appear y and the patient rapidly sinks. 

Asthenic- laryngitis, or oedema of the glottis, is generally con- 
fined to the upper part of the larynx, the constriction being 
caused by infiltration of the margins of the larynx and epi- 
glottis. The disease commences with a continually increasing 
impediment to respiration, and a feeling of fullness and con- 
striction, and continuous desire to clear the throat, as if 
caused by some foreign body; the voice becomes hoarse, 
croupal, then sharp, stridulous, whispering, and is then lost 
entirely; there is a hoarse convulsive cough, with fits of suf- 
focation, causing great agony. While inspiration is pro- 
longed, stridulous and exceedingly difficult, expiration is com- 
paratively easy. This feature is so marked as to be pathog- 
nomonic of the disease. There is no fever, but as the disease 
progresses the pulse becomes frequent, small and irregular. 
The difficulty of breathing increases ; the fits of coughing 
and suffocation are more frequent; symptoms of asphyxia 
are very apparent, the* cerebral functions are disturbed, and 
at last death ensues-from inability to inflate the lungs. 

Diagnosis. — The diagnosis is readily made in these cases, 
from the peculiar character of the voice, cough, location of 
soreness and constriction, and extreme difficulty of breathing; 
in asthenic laryngitis, by the marked difficulty of inspiration, 
and freedom of expiration. 

Prognosis. — The prognosis is favorable in the first form, 
and even in the second, if the treatment is prompt and active, 
but doubtful in the third. 

Post-Mortem Examination. — The mucous membrane of the 
larynx in acute inflammation is found red, congested, and thick- 
ened, with slight sub-mucous infiltration in some cases. But 
in none is there sufficient closure of the opening to account 
for the death by asphyxia: we have, therefore, to attribute it 
in part to spasmodic or tonic contraction of the intrinsic 
muscles of the larynx. In asthenic laryngitis the sub-mucous 



Acute Laryngitis. 105 

cellular tissue of the under surface of the epiglottis, and mar- 
gin of the glottis, and even as far down as the ventricle of 
the larynx, is infiltrated with serum, readily accounting for 
the difficult inspiration. 

Treatment. — In catarrhal laryngitis, the treatment is simple. 
I direct frequent inhalations of the vapor of Water, until 
expectoration commences, giving, at the same time, equal parts 
of the Acetous Tinctures of Lobelia, Sanguinaria, and Simple 
Syrup in moderate doses, every quarter or half hour, with the 
hot foot-bath, some warm diaphoretic, and the Stillingia Lini- 
ment applied to the throat. 

In the acute affection, means to cause relaxation of the 
larynx are of the utmost importance, giving us time to arrest 
the inflammation. For this purpose, we employ cloths wrung 
out of hot water, frequently changed, and the additional use 
of equal parts of Oils of Lobelia and Stillingia, with just suffi- 
cient Alcohol to cut them. Dry cups, or the cups and scarifi- 
cator may be employed with marked advantage, if properly 
used. In addition, inhalation of equal parts of Vinegar and 
"Water, or either alone, is highly useful. Counter-irritation 
should be thoroughly employed to the spine and to the extremi- 
ties, and for the same purpose, in the early stage of the disease, 
a brisk cathartic may be administered. 

Internally, the most efficient remedies are the Acetous Tinc- 
tures of Lobelia and Sanguinaria, and Syrup, equal parts, 
given in tablespoonful doses every five or ten minutes. It 
should be employed so as to keep up continuous nausea, but 
not to produce vomiting, unless it is found that such nausea 
does not produce the general relaxation necessary, when the 
Compound Powder of Lobelia, in infusion, may be given so as 
to produce thorough and sufficiently continued emesis to 
accomplish the desired result. 

Asthenic laryngitis is more difficult to manage, our principal 
resources being those that produce revulsion. Thus, we employ 
stimulant applications to the throat, with the dry cups, or, in 
lieu of this, the cups and scarificator. The back, loins, hips 
and extremities should be thoroughly rubbed with the Tinc- 
ture of Capsicum, repeated as often as it seems necessary. 
Internally, a stimulant Hydragogue cathartic might be admin- 
istered, and followed by Stimulants, Tonics, and the Chlorine 
salts. Inhalations of a slight stimulant character has proven 
advantageous, but further than this, treatment directed to the 



106 The Eclectic Practice of Medicine. 

respiratory passages is worse than useless. It is stated, upon 
good authority, that in the early stage of the affection, a stimu- 
lant emetic of Lobelia, carried to its farthest limit, has cut 
short the disease at once, and I would be disposed to try it in 
a person naturally feeble, in preference to other modes of treat- 
ment. 



CHROISriC LARYNGITIS. 

Chronic laryngitis may arise from an improperly treated 
catarrhal laryngitis, quite frequently from an extension of the 
chronic inflammation of the pharynx, heretofore spoken of, 
downward to the larynx. Great and prolonged exercise of 
the voice, as in public speaking, singing, etc., is a prominent 
cause. Syphilis, also, not unfrequently affects the larynx, the 
result being almost certain death. 

Symptoms. — Chronic laryngitis usually comes on slowly and 
insidiously, the patient being hardly aware that he is suffering 
from a serious disease, until it is confirmed. The first symp- 
toms are soreness of the throat when speaking, with constric- 
tion, slight alteration of the voice, cough, and expectoration, 
which comes on after slight exposure, or over-exertion of the 
larynx. These symptoms are ameliorated in a short time, 
and the patient thinks it but a slight cold, from which he is 
recovering. As time advances, however, the attacks become 
more frequent, last longer and do not so nearly disappear. 
The disease being fully established, there is a constant uneasy 
sensation in the region of the larynx, the voice is seriously 
altered, and there is a constantly annoying cough, with expec- 
toration. The expectoration is at first scanty and mucus; but, 
as the disease advances, it is muco-puriform, sanious, con- 
creted into lumps, or consists of almost pure pus. Hemor- 
rhage occurs in the latter stages, sometimes in very large 
quantity. If the throat is examined, we notice the evidence 
of chronic inflammation of the fauces, pharynx, and epiglottis, 
and we reasonably suppose that the mucous membrane of the 
larynx corresponds in appearance; with the laryngiscope we 
are enabled to view the internal surface of the larynx, and 
determine its condition tolerably accurately. 

The impairment of the general health is usually in direct 
ratio to the severity of the local affection. At the com- 



Chronic Laryngitis. 107 

men cement, the patient complains simply of debility, with 
some failure of the digestive organs, and sometimes torpor of 
the secretions. When it has progressed for some months he 
is unable to attend to business; there is loss of flesh and 
strength, marked impairment of the digestive functions and 
of excretion. Now, frequently the system becomes so de- 
pressed that tubercles are deposited in the lungs, the symp- 
toms of phthisis are developed, and the disease runs a rapid 
course to a fatal termination. 

Diagnosis. — We diagnose chronic laryngitis by the unpleas- 
ant sensations in the region of the larynx, the cough and 
expectoration, the appearance of the throat, and the absence 
of physical signs of other disease of the respiratory apparatus. 

Prognosis. — The prognosis is not favorable, as but few have 
the patience necessary to persist in the use of remedies until a 
cure is effected. It can be cured, but it requires time and 
perseverance, otherwise the disease is as fatal as confirmed 
phthisis. 

Post-Mortem Examination. — The lesions revealed by the 
scalpel are various : sometimes there is simple thickening of 
the mucous membrane, with enlargement of the follicles, at 
others there is superficial ulceration or large deep, ragged, and 
sloughy ulcers, sometimes invading, or even perforating the 
cartilages. The lungs and bronchia are variously affected, 
tuberculosis being the most frequent condition. 

Treatment. — A very important part of the treatment in 
this affection is that directed to a restoration of the general 
health ; and for this purpose remedies can also be selected so as 
to exert a beneficial influence upon the local disease. As a 
general tonic, I employ the Ptelea Trifoliata, the Achillea Mil- 
lefolium, the Cornus Florida, Populus Tremuloides, etc., in the 
form of essential tincture, adding the Cinchona in the form 
of ferrated 'tincture when it seems necessary. The Hypophos- 
phites have proven beneficial in this affection, and may be 
employed with the tonics and Cod-Liver Oil. Especial atten- 
tion should be paid to the excretions — the skin stimulated to 
action by the use of appropriate baths, generally of a stimulant 
character — the kidneys by small portions of the alkaline diu- 
retics — and the bowels by mild laxatives and habits of regu- 
larit} T . The tonics and other agents will have to be changed 
frequently, as remedies soon lose their influence upon the 
system. 



108 The Eclectic Practice of Medicine. » 

For the local disease we use remedies taken internally, in 
the form of inhalation, insufflation, and direct application. In 
cases attended with deficient secretion the Nauseant Expecto- 
rants may be used with advantage, and if the laryngitis is com- 
plicated with bronchitis, the proper expectorant should be 
employed. Otherwise we employ remedies not for their gen- 
eral influence when absorbed from the stomach, but for the 
impression made upon the throa*t whilst they are slowly swal- 
lowed, or the throat is gargled. Thus, for the relief of the 
troublesome cough, nothing has proven more efficient than 
#, Oil of Stillingia, Oil of Lobelia, Oil of Cajeput, aa, 3iij ; 
Alcohol, giv; mix, and give in doses of from one to two 
drops on a lump of sugar, every three or four hours. Small 
portions of Morphia, Extracts of Indian Hemp, Hyoscyamus, 
Belladonna, etc., combined with Mucilage and Simple Syrup, 
may be used in the same way. The treatment named under 
the head of chronic pharyngitis stimulant and tonic gargles, 
is applicable in a large majority of cases, as the two diseases 
are associated together. 

Inhalations are of much advantage, as by this means we may 
relieve the irritation and cough, and produce a stimulant, 
tonic, or astringent action, directly. If there is much irritation 
and dryness, Aqueous vapor should be the vehicle, and Lobe- 
lia and relaxants, with suitable narcotics or sedatives to relieve 
the cough, the agents of inhalation. If less irritation, the 
vapor of Vinegar is the best vehicle in many cases, though 
diluted Alcohol or Water may be employed. As tonics, a 
strong decoction of Hydrastis, Tincture of Humulus, Cornus, 
Populus, Trillium, etc., may be employed ; as an astringent, 
Tannic Acid, or the astringent preparations of Iron ; as stimu- 
lants, the Sanguinaria, Podophyllin, Xantoxylin, Myrrh, Bal- 
sam of Peru, of Canada, of Tolu, Tar, Resin, Creosote, Iodine, 
etc. By insufflation any agent may be employed 'that would 
produce a beneficial influence by contact, the agent being 
readily soluble in the fluids of the part. Thus I have used 
finely powdered Hydrastine, Beeberina, and Camphor, as a 
stimulant and tonic ; Tris-Mtrate of Bismuth, Morphia, Ses- 
quicarbonate of Potassa, etc., for the relief of pain and irrita- 
tion ; and #, Nitrate of Silver, grs. iij, vel, x; Tannic Acid, 
3j, to arrest hemorrhage, and check too profuse secretion. In 
using these agents, we put the finely pulverized agents in a 
small tube, and pass it back until the extremity is over the 






Croup. 109 

opening of the glottis, then let the patient draw his breath 
through the tube. 

Externally we direct continuous counter-irritation to the 
sides of the larynx, sometimes with the irritating plaster, at 
others with the Fly blister, and at others by a plaster of Gal- 
banum, or Common Pitch and Capsicum. Sometimes it is 
advantageous to apply the counter-irritant immediately below 
and behind the ear, and the posterior and upper part of the 
neck. Quietude of the part is of the greatest importance. 
The great difficulty in accomplishing a cure is the continued 
movement and consequent irritation. Public speaking and 
singing should, therefore, be entirely prohibited, and the larynx 
used as little in conversation as possible. 

I have not yet spoken of Nitrate of Silver, the multum in 
parvo of certain practitioners — the agent which singly and 
alone was to cure this very serious affection. That it may aid 
in effecting a cure by its stimulant influence I do not deny, but 
I claim that its improper use has caused more injury than its 
application has ever done good. It may be advantageously 
used as an application to the pharynx, fauces, base of tongue, 
and near the larynx, as heretofore recommended ; but the pro- 
bang should never be passed into the larynx — if the solution 
must be passed into the larynx, use the rubber syringe with 
curved silver tube closed at the extremity, and perforated with 
minute openings, pass it caref ally and quickly into the larynx, 
and inject the solution. Many persons who use the probang 
and Nitrate of Silver in this disease never pass it into the larynx 
at all. I might say that not one out of ten accomplish the 
object. This being the case, the treatment should be aban- 
doned ; but much more so, considering the fact that the remedy 
will not cure chronic inflammation of any part of itself. 



CKOUP. 



Croup is essentially a disease of the larynx, and true croup 
has also been termed laryngitis, but it is well enough to retain 
the name croup for the affection of children, as it differs very 
materially from the laryngitis of the adult. Three forms of 
croup have been described, each having characteristic symp- 
toms; they are, the mucous, pseudo-membranous, and spas- 
modic. 



110 The Eclectic Practice of Medicine. 

Symptoms of Mucous Croup. — This form of the disease is 
frequently preceded by well marked symptoms of coryza, and 
sometimes a stuffing up of the breast, slight difficulty of respi- 
ration, a cough, and a general "bad cold." The attack of 
croup generally comes on at night, the little patient being 
restless and uneasy, and the respiration rough and whistling. 
Soon it awakes with a hoarse croupy cough and sensation of 
choking, appears frightened, breathes laboriously, and con- 
tinues the cough until a portion of mucus is raised, when the 
spasm passes off and it breathes freer. In a short time respi- 
ration becomes permanently difficult, and there is a peculiar 
whistling and gurgling as the air passes through the larynx. 

The cough is hoarse, shrill, gurgling, with a marked ringing 
metallic sound. The voice is changed, becoming shrill and 
piping, and at last sinks to a whisper, even the cry being whis- 
pering at first, terminating in a shrill piping sound. If the 
child sleeps, mucus accumulates in the throat, the breathing 
becomes more and more difficult, and at last the child awakes 
with symptoms of imminent asphyxia. At first the skin is dry, 
its temperature slightly increased, and the pulse full and hard ; 
but as the respiration becomes more difficult, a cold clammy 
perspiration breaks out, the extremities become cold, and the 
pulse frequent and feeble. The difficulty of breathing and 
other symptoms continuing to increase, the disease terminates 
fatally from twelve to forty-eight hours from its commence- 
ment. 

Pseudo-Membranous Croup. — This form of the disease comes 
on slowly and insidiously ; the first symptoms being a dry 
whistling inspiration, a slight metallic cough, and some alter- 
ation of the voice. These symptoms continue to increase for 
tw r o, three, or four days or more, before the final paroxysm, 
the child meanwhile appearing tolerably well, with the excep- 
tion of the symptoms named. The day previous to the final 
attack these symptoms frequently become so marked as to 
excite notice, and mild measures are used for its relief. 

Finally the respiration becomes very laborious, both inspira- 
tion and expiration being hard and w T histling. The cough is 
hoarse, dry, ringing and metallic. The voice sinks to a whis- 
per, is shrill and stridulous. The ear applied to the larynx 
detects at once the evidence of stricture, and the want of secre- 
tion. As the disease progresses, the child is attacked b} 7 fits 
of suffocative cough, the lips become livid, the countenance 



Croup. Ill 

congested, the extremities cold and clammy, coma makes its 
appearance and the child dies. 

Spasmodic Croup. — This is the most frequent form of the 
disease, and is dependent, doubtless, on slight inflammation, 
giving rise to spasmodic contraction ; cold and sadden atmos- 
pheric changes being the most frequent causes. Like mucous 
croup, it usually comes on at night, though the breathing may 
have been difficult with a croupy cough and voice through the 
preceding day. The child is usually awakened by difficulty 
of breathing, a hoarse, ringing, metallic cough, and a shrill 
whispering voice or cry. In some cases there is slight secre- 
tion, but in others none at all. The difficulty of respiration 
increases for a few minutes, or in some cases for an hour or 
two, then gradually passes off; sometimes there are marked 
exacerbations and remissions occuring every few minutes. 
There is but little derangement of the secretions or circulation, 
and it is not difficult to detect the spasmodic character of the 
affection. 

Diagnosis. — The peculiar cough, tone of voice or cry, and 
shrill respiration, is so characteristic that no one could mistake 
a case of croup for any other affection. When, however, we 
come to make the distinction between the varieties of the dis- 
ease named we find considerable difficulty. In the mucous 
variety, there is the gurgling sound indicative of mucous accu- 
mulations; as it continues to accumulate, the respiration 
becomes more difficult, and when a portion is discharged by 
coughing, the patient seems relieved. In pseudo-membranous 
croup, there is the peculiar dry, metallic respiration, cough, 
and cry, with no evidence of secretion. In the spasmodic 
form, the disease is not so intense, we notice temporary relax- 
ation of the larynx in which the child breathes freely, and 
there is but little if any constitutional disturbance. 

Prognosis. — In the mucous and spasmodic form of croup 
the prognosis is favorable ; in the pseudo-membranous it is 
doubtful, prompt and efficient treatment being always required 
to effect a cure. 

Post-Mortem Examination. — The scalpel demonstrates con- 
clusively in this affection, that spasmodic contraction of the 
intrinsic muscles of the larynx played an important part in 
rendering it fatal. In fact I do not belive that any would die 
if it were in our power to produce complete paralysis of these 
muscles in the early stage of the affection. In mucous croup 



112 The Eclectic Practice of Medicine. 

we find the mucous membrane reddened, slightly thickened, 
and sometimes with submucous infiltration ; this does not, 
however, greatly lessen the caliber of the larynx. In addition 
there is more or less accumulation of mucus. In the pseudo- 
membranous form, the false membrane lessens the caliber of 
the larynx from one-fourth to one-third, there being still room 
for the passage of the necessary amount of air, if it were not 
for the contraction above named. 

Treatment. — In mucous croup I generally employ equal 
parts of Acetous Tinctures of Lobelia and Sanguinaria, and 
Simple Syrup, giving it in teaspoonful doses sufficiently often 
to produce and keep up continuous nausea. Continuing this 
until from the peculiar loose, gurgling sound of the respira- 
tion and cough we know that the secretion is less tenacious, 
we carry it to thorough emesis. Sometimes this ends the dis- 
ease, but at others it is necessary to still continue the remedy, 
and repeat the emetic two, three, or more times. As an adju- 
vant, though a very important part of the treatment, we use 
applications of Water and Vinegar to the throat, as hot as it 
can be borne, and renewed frequently, or the Compound Still- 
ingia Liniment heretofore spoken of, or a plaster made by 
sprinkling Snuff on a cloth spread with Lard, or in quite 
young children, the Emetic Powder used in the same way. 
Counter-irritation to the spine, with the hot Mustard foot- 
bath, and the general sponge bath if the skin is dry and con- 
stricted, are very useful. Inhalations of Vinegar and Water, 
or of Vinegar, tend to relax the parts, and thus give tempo- 
rary relief, and by rendering the mucus less viscid they aid 
the permanent cure. 

In the pseudo-membranous variety, the indications are to pro- 
duce relaxation and thus prolong the patient's life and give a 
longer time for the action of medicine, to cause effusion be- 
neath the false membrane and break down its plasticity, and 
having thus caused its partial detachment, to cause its removal 
by an act of emesis. To fulfill the first indication, we direct 
the continuous application of flannel cloths, wrung out of hot 
water to the throat, the use of the Stillingia Liniment; or, if 
the case is urgent, the Oil of Lobelia applied freely. In addi- 
tion, I have found inhalations of Vinegar of marked import- 
ance, and in some cases I have added the Extract of Belladonna 
and the Tincture of Gelseminum. Cups to the throat prove 
very serviceable in many cases, but rubefacients should not be 



Croup. 113 

used. The hot Mustard foot-bath and counter-irritation to 
the spine are also useful. 

Internally I emply, #, Acetous Tinctures of Lobelia and 
Sanguinaria, aa f3j ; Molasses, 3j ; Chlorate of Potassa, finely 
powdered, 3j ; mix, and give to a child two or three years old 
a teaspoonful every five or ten minutes, until nausea is induced, 
then less frequently. If there is much constriction of the 
skin and excitation of the pulse, I add the Veratrum in suita- 
ble doses. The remedy above named should be given without 
any fluid either before or after it, as we desire its local influ- 
ence as it is swallowed, as much as its general influence when 
taken into the stomach ; in no case should it be allowed to 
produce vomiting until we have direct evidence, in the gurg- 
ling and flapping sound of respiration, that the false mem- 
brane is becoming loosened. If the tendency to vomiting 
should be strong, I direct the sinapism to the stomach, and 
an infusion of Peach Bark with the nauseant, as an anti- 
emetic. A variable length of time will elapse before the 
pseudo-membrane will be loosened sufficiently to be dis- 
charged, sometimes five or six hours; in one case that I treated, 
sixty hours. When, from the sound, we are satisfied the de- 
tachment is sufficient to permit the evacuation of all or part, 
we induce speed} 7 emesis, usually with an infusion of our com- 
mon emetic powder, as preferable to the agents we have been 
using. The more thorough and effective the emetic, the 
greater the chance of safety, though in some cases we find the 
false membrane thrown up in shreds by coughing, without any 
indication for an emetic at all. Usually the Lobelia and San- 
guinaria used as above directed, and continued for so long a 
time, act upon the bowels, sometimes giving rise to great irri- 
tation. In such case, agents to obviate this must be employed. 
The treatment is brief, but nothing can be added to it in our 
present knowledge of the Materia Medica, and there are no 
agents we can substitute for those named, and no preparations 
of the agents but the Acetous Tinctures. 

Spasmodic croup is easily treated ; very frequently the Com- 
pound Tincture of Oils of Lobelia and Stillingia, heretofore 
named, freely applied externally, with the internal adminis- 
tration of a drop every half hour or hour, on a lump of Sugar, 
answers our purpose. Or the warm Onion poultice to the 
throat with the internal use of almost any nauseant succeeds. 

The compound of Lobelia, named under the head of mu- 
9 



114 The Eclectic Practice of Medicine. 

cous croup, is very efficient; in fact, the entire treatment 
named there may be adopted in this case. Generally, how- 
ever, the milder the measures for relief, the better it will be 
for the patient, as the stronger agents so change the action of 
the bronchial mucous membrane as to prove a source of 
difficulty. 



APHONIA. 

Aphonia or loss of voice may be either temporary or perm- 
anent, unless overcome by medicinal measures. In the first, 
the condition of the vocal cords is changed; in the second, a 
more permanent structural lesion of these, or paralysis of the 
nerves distributed to the intrinsic muscles of the larynx. 
Temporary aphonia in a greater or less degree is witnessed in 
acute or catarrhal laryngitis, aud in croup, and in some cases 
of cold, in which it is the only indication of laryngial affec- 
tion. Permanent aphonia may result from thickening of 
the mucous membrane covering the vocal cords, from ulcera- 
tion, or from change in the structure of the cords themselves, 
the result of inflammation. Or, as before stated, it may de- 
pend upon paralysis of the intrinsic muscles of the larynx, 
caused by inflammation, excessive exertion of the vocal 
organs, excessive emotional excitement, or from lesion of the 
brain, or of the nerves passing to the larynx. 

Symptoms. — In the first class of cases, the voice sinks to a 
whisper, and there are prominent symptoms of inflammatory 
disease of the larynx. In some of these cases, as has been 
determined by the laryngoscope, the inflammation is con- 
lined entirely to the vocal cords. In the second, if produced 
from inflammation, the voice is gradually lost, and from the 
persistent cough and mucus, or muco-purulent expectoration, 
we are satisfied as to the change of structure about the ven- 
tricle of the larynx. In cases of paralysis of the larynx, 
the loss of voice may have been sudden or gradual, and 
marked by inflammation or otherwise. 

Diagnosis. — A very important point to determine in this 
affection is the producing and continuing cause ; the loss of 
voice is apparent to all. Having ascertained all the facts in rela- 
tion to its commencement, we can readily determine whether 
inflammation has existed or not. If cough exists, if there is 
expectoration, with tenderness on pressure over the thyroid 



Aphonia. 115 

cartilage, without bronchitis, we are satisfied that the inflam- 
mation continues in a chronic form; if the laryngoscope is 
used, the structural lesions can be accurately analyzed. If 
there is neither cough nor expectoration, nor soreness on pres- 
sure over the larynx, we may judge it to be paralytic. It 
must not be forgotten that the larynx is governed to a con- 
siderable extent by the reflex system of nerves, and a tempo- 
rary aphonia may be the result of disease of other portions of 
the body, as in cases of hysteria. 

Prognosis. — It will be evident from the above that the 
prognosis will be dependent upon the cause and the persistence 
of the affection. In a large majority of cases the voice can 
be restored. 

Treatment. — In the first class of cases we find but little dif- 
ficulty in the treatment, as with the disappearance of the inflam- 
mation the voice is restored. In addition to the other means 
named, I have employed the Compound Tinctures of Oils of 
Lobelia and Stillingia as an external application, and as an 
inhalation, with marked advantage. As an inhalation, I 
direct that a coarse, open sponge be wrung out of hot water, 
and the Tincture, in small quantity, being dropped on it, it is 
held to the mouth, and the breath drawn through it. This 
will be found an efficient plan of using remedies in laryngitis. 
Counter-irritation seems to be productive of little benefit, but 
if the case is acute cups are used with advantage. In the 
treatment of laryngitis with aphonia, the treatment should 
be prompt and thorough, as the ventricle of the larynx, which 
is now ascertained to be affected, being the smallest part, may 
be speedily so closed as to arrest respiration. 

In chronic cases, arising from inflammation of the larynx, the 
treatment proper for the laryngitis should be adopted. It is in 
these cases especially that stimulant applications directly to the 
part affected have been found beneficial. The titrate of Silver 
is solution is generally relied upon, but, from the difficulty in 
its use, is not generally applicable. The inhalations recom- 
mended under the head of chronic laryngitis are most applica- 
ble in these cases, with counter-irritation externally, if there is 
much irritation, and stimulant applications if there is atony. 

In aphonia from paralysis, stimulant inhalations are some- 
times very efficient, as for instance: #, Oil of Cajeput, Oil of 
Stillingia, aa, 3j ; Alcohol, gij ; to be used with the sponge as 
recommended above. The Oil of Sassafras, and Hemlock; 



116 The Eclectic Practice of Medicine. 

with Alcohol, in the same proportions, is also good, as is also 
the Vinegar of Sanguinaria, Tincture of Myrrh, Balsam of 
Toln, etc. Stimulant applications externally, in the milder 
cases, are effectual; a tincture of any of the essential oils 
may be employed, but I prefer #, Oil of Sassafras, Oil of Caj- 
eput, Oil of Stillingia, aa, 3j ; Alcohol, 3iij ; mix, and apply 
freely and frequently. Electricity in the form of the Electro- 
magnetic or Galvanic current passed through the larynx, and 
from the occiput downwards through it, is frequently a great 
aid to the treatment. Intern ally, the Extract of Nux Vomica 
or Strychnia, or, in some cases, Belladonna or Ergot may be 
beneficially used. 



ACUTE BRONCHITIS. 

Acute bronchitis may be divided into three varieties: First, 
common catarrhal bronchitis; second, sthenic bronchitis; 
third, asthenic bronchitis. The first of these has sometimes 
been denominated cold in the chest, the inflammation being 
subacute as in common catarrh. In the second the inflamma- 
tion is active, and the disease consequently severe. The third 
is inflammation of an asthenic character, and occurs in per- 
sons of feeble vitality, or where there is especial loss of tone 
in the respiratory passages. 

Symptoms of Catarrhal Bronchitis. — This affection com- 
mences as a common cold, the patient feels dull and languid, 
frequent chilly sensations alternated with flushes of heat, 
increased secretion from the nose, dry skin, constipation of 
the bowels, and headache. In a short time the patient com- 
plains of a sense of dryness and roughness, and makes fre- 
quent attempts to clear the throat. A hard, dry cough, more 
or less hoarse, is soon developed, and seems to be rendered 
much worse by tickling in the fauces. The voice is frequently 
hoarse, there is a sense of tightness and constriction of the 
thorax, with slight pain or soreness in coughing or drawing a 
long breath. In some cases the febrile reaction is quite 
marked for the first two or three dajs. By the second or 
third day, the patient commences to expectorate a thin gilary 
fluid, which, rising to the glottis, greatly increases the desire 
to cough. By the fourth or fifth day the secretion has 
increased in quantity, is yellowish and opaque, and is raised 
with greater freedom. The constitutional symptoms now dis- 



Acute Bronchitis. 117 

appear r though the cough may continue for several days, and 
the patient soon recovers. 

Symptoms of Sthenic Bronchitis. — Sthenic bronchitis is fre- 
quently preceded for a short time by coryza, oppression of 
the chest, languor, listlessness, arrest of the secretions, etc. In 
a short time marked chills or rigors are noticed, sometimes 
the chilly sensation will continue for twelve or twenty-four 
hous, not very severe, but annoying to the patient. The chill 
is followed by fever, generally remittent in character, being 
the highest in the afternoon and evening; the skin is hot, dry 
and husky, the pulse frequent and hard, the mouth dry, tongue 
coated white and contracted, bowels constipated, and urine 
scanty and high colored. With the first appearance of febrile 
reaction a hard, dry and deep cough makes its appearance, 
the respiration becomes laborious, and there is dyspnoea 
and oppression of the chest. Geuerally within the first 
twenty-four hours a dull pain is experienced on coughing. 

About the third da} 7 we find the cough violent and harass- 
ing, it is still dry and productive of pain, the thorax seems 
sore as if bruised, and respiration is more difficult; the pulse 
is more frequent, and the secretions still farther arrested. The 
tongue is now coated and foul, and the appetite entirely gone; 
the patient is restless and uneasy, and sleeps poorly at night 
on account of the cough and difficult respiration. If we 
examine the thorax during this stage of the disease, we will 
find that the respiratory murmur is masked by a dry sound 
developed in the bronchial tubes, the result of inflammation : 
this sound approximates that produced by blowing through a 
dry tube, and is termed the sibilant ronchus, or whistling res- 
piration. The extent of the thorax over which this sound is 
heard, determines the extent of the bronchitis. We dis- 
tinguish it from the bronchial sound produced by consolida- 
tion of the lungs, by percussion which gives normal reso- 
nance. 

Expectoration commences from the third to the sixth day. 
At first it is a clear, transparent mucosity, secreted in small 
quantity, and raised with difficulty. In a day or two it is a 
tough glairy mucus, resembling white of egg, and in most 
cases streaked with blood. As a general rule, it may be stated, 
that the greater its tenacity, the more intense the inflam- 
mation of the mucous membrane secreting it. This mucus is 
expectorated with difficulty; it accumulates, gives rise to 



118 The Eclectic Practice of Medicine. 

cough, which is much protracted, lasting sometimes for min- 
utes before the adhesive mucus gives way. The physical 
signs have not yet changed materially, though the sibilant 
rhoncus has become modified, and as mucus accumulates 
previous to coughing, is changed to a mucous sound. The 
febrile symptoms are still intense, and the difficulty of respira- 
tion, and oppression of the chest as great. 

From the fifth to the eighth day a marked change is noticed 
in the mucus expectorated, it now contains opaque, yellowish, 
greenish, or white masses, suspended in the glairy mucus. 
These increase in quantity as the disease progresses, until the 
entire expectoration possesses these properties. We now notice 
a marked change in the physical signs, the sounds being moist, 
and are termed mucous rhonci. With this change in the 
expectoration the fever gradually abates, the secretions are 
restored, the appetite returns, the patient rests at night, the 
cough not being so troublesome, and the breathing becomes 
easy. The amendment continuing, by the eighth to the twelfth 
day the patient is convalescent. This may be said to be the 
natural course of the disease; but these changes can be very 
much accelerated by medicines, and the disease made to run 
a much shorter course. 

Sthenic bronchitis does not always terminate thus favorably. 
Occasionally it is noticed that about the fifth or eighth day, 
when improvement should have commenced, that the respira- 
tion becomes laborious, the patient complains of great op- 
pression of the chest, wants his shoulders propped up, and 
his arms out to bring into play the external inspiratory 
muscles. The system now begins to exhibit the evidences of 
imperfect aeration of the blood, in the purplish color of the 
lips and tongue, and the livid paleness of the surface. The 
expression of the countenance is anxious and distressed ; 
delirium comes on, at first partial, at last complete, the 
extremities are cold, at last the entire surface is cool, and 
bathed with a cold, clammy perspiration, and the patient dies 
asphyxiated. 

Diagnosis. — The diagnosis in this disease is not difficult. 
The marked fever and arrest of secretion, determines an acute 
inflammation; the cough, oppression in the chest, and dull, 
obtuse pain, that the respiratory organs are affected; the 
sibilant followed by the mucous rhoncus, with resonance on 
percussion, that it is confined to the bronchial tubes. The 



Acute Bronchitis. 119 

stage of the disease is determined by the expectoration, rhon- 
cus, and the general symptoms. 

Prognosis. — Though a severe disease, we do not look upon 
it as a fatal one, though occasionally from its intensity it 
becomes difficult to manage. If secretion commences, be- 
comes opaque, easily expectorated, with an abatement of the 
fever, the case is progressing well, but if symptoms of imper- 
fect depuration of the blood are developed, with delirium, the 
case is a grave one. During the disease, if the sputa changes 
from an opaque to a glairy white mucus, we may be satisfied 
that the inflammation is redeveloped in its original intensity. 

Post-Mortem Examination.. — If a patient suffering from 
acute bronchitis should die of some other affection, we would 
find the bronchial mucous membrane thickened and red, and 
bathed with the secretion expectorated previous to death. 
When the disease terminates fatally itself, the mucous mem- 
brane has been found red and thickened, and affected through- 
out the lung, and the bronchial tube more or less choked up 
with accumulated mucus. 

Symptoms of Asthenic Bronchitis. — This is the peripneu- 
monia notha of authors and generally occurs in very young or 
old persons, or in those of exhausted constitution, or who 
have been liable to coughs with profuse watery expectoration. 
It usually commences with symptoms of cold and oppression 
in the chest, with slight febrile reaction. The cough is severe, 
occurring in paroxysms, the breathing is oppressed, laborious 
and wheezing, the expectoration scanty at first, soon becomes 
abundant, thin and frothy. The pulse is quick, small and 
irregular, the heat of the surface but little if any increased, 
the extremities generally being cool ; the tongue is loaded 
with a foul, dirty mucus, the appetite is gone, and the bowels 
constipated at first, become irregular as the disease advances. 
As the disease becomes more intense, the countenance is pale 
and anxious, there are exacerbating fits of dyspnoea, in which 
it seems almost impossible for the patient to breathe, and if 
the patient attempts to take a full breath to relieve this, or 
changes his position, a severe fit of coughing is brought on, 
sometimes terminating in vomiting which gives temporary 
relief. If the case terminates fatally, the tongue becomes 
livid, the face dusky, the patient can not lie down, and if he 
sleeps it is but for a few moments, and wakes threatened with 



120 The Eclectic Practice of Medicine. 

impending suffocation, delirium sets in, with cold, clammy 
perspiration, and the system is soon exhausted. 

In weak and poorly nourished children, this disease is of 
frequent occurrence. At first it is noticed that the little pa- 
tient has a protracted chill, followed by febrile exacerbation. 
The fever is higher in the afternoon, but becomes less and less 
marked as the disease advances. Eespiration is quick and 
wheezing, the pulse frequent and full, though soft and easily 
compressed. The cough is persistent, deep and hollow, the 
expectoration, at first a viscid mucus, becomes, as the disease 
advances, yellowish, greenish and opaque. Dyspnoea is mark- 
ed when the disease is fully developed, and coming on in 
paroxysms it is followed by a long harrassing cough, which 
frequently terminates in vomiting, giving relief for the 
time being. The disease sometimes continues for days, or 
even weeks, terminating favorably ; or the dyspnoea becoming 
more intense, we observe symptoms of asphyxia rapidly 
increasing, and the child dies of apncea. 

Diagnosis. — We form our diagnosis in this affection, by 
the low grade of febrile reaction, marked derangement of 
function, and prostration, that the inflammation is asthenic; 
by the cough and difficulty of respiration, that the respiratory 
organs are the seat of the disease, and by the presence of 
the mucous rhoncus and resonance on percussion, that the 
bronchial tubes are the parts involved. 

Prognosis. — When the disease is mild, a favorable prog- 
nosis may be given, but when severe, it is an exceedingly dan- 
gerous affection, and our prognosis must be guarded. 

Treatment. — In catarrhal bronchitis, as well as in the 
sthenic form, our object is to arrest the inflammation at once ; 
in the early stage this can be accomplished. Thus, if we 
induce copious perspiration, by the use of the spirit vapor 
bath, and the internal administration of the Compound Tinc- 
ture of Serpentaria, or an infusion of Asclepias, Eupatorium, 
Potygonum or other efficient diaphoretic, following with small 
doses of some nauseant expectorant, as #, Acetous Emetic 
Tincture and Simple Syrup, aa, administered in teaspoonful 
doses every hour until expectoration is established, we accom- 
plish our object. We reach the same end by the admin- 
istration of a thorough emetic, followed by warm diaphoretic 
infusions, and a nauseant expectorant. Or early in the disease 
#, Tincture of Gelseminum, 3 j ; Acetate of Potassa, 3ss; 



Acute Bronchitis. 121 

"Water, 3iv; mix. and give in teaspoonful doses every two 
hours; a free action on the bowels with the Compound 
Podophyllin Pill, assists very much in the cure. The warm 
bath, with inhalations of equal parts of Yinegar and "Water, 
and the use of small doses of Tincture of Yeratrum and 
Aconite, will also prove efficient. If the cough continues, 
treat it as hereafter recommended, 

In the first stage of sthenic bronchitis we endeavor to arrest 
the fever, and obtain secretion, which, if accomplished, arrests 
the disease. Several modes of treatment are adopted to 
accomplish this, but all of them are either directly or indi- 
rectly sedative. A very pleasant and efficient plan is to put 
the patient on the use of special sedatives ; $?, Tincture of 
Yeratrum, 3j ; Tincture of Aconite, 3ss; Tincture of Gelsem- 
inum, 3ss; Acetate of Potassa, 3iij; Water 3vi; mix, and give 
a teaspoonful every hour. This should be assisted by the hot 
foot bath and hot fomentations applied to the thorax, and in- 
halations of aqueous vapor, the air of the room being kept 
continually moist. "With this treatment the patient is usually 
convalescent by the fifth day, and there is rarely any subse- 
quent cough and expectoration. If it is preferred, an emetic 
of the Compound Powder of Lobelia and Capsicum in infu- 
sion, may be administered so as to produce protracted nausea, 
then thorough emesis, and its diaphoretic influence continued 
by the hot foot bath, hot applications to the extremities, fo- 
mentations to the chest, and the administration of some warm 
diaphoretic infusion. This, followed by the administration of 
a saline diuretic, and a cathartic if necessary, and occasionally 
small closes of the sedatives, frequently arrests the disease. 
Or sedation may be effected by the employment of the spirit 
vapor bath, and the use of nauseant diaphoretics, with the 
other measures named above. Formerly the treatment con- 
sisted in the administration of nauseants to favor secretion, 
and diaphoretics, diuretics, and cathartics to start the excre- 
tions ; if properly pursued, it is very effectual. Lobelia, 
Sanguinaria and Ipecacuanha were the remedies most fre- 
quently employed, and in order to obtain the full benefit from 
their administration, they should be employed in such doses, 
and at such times as to produce continuous nausea ; if given 
at long intervals so as to allow the nausea to pass off between 
the doses, the treatment is frequently unsuccessful. 

With the means named above, expectoration is usually 



122 The Eclectic Practice of Medicine. 

established in a couple of days, and the severer symptoms 
mitigated. It was remarked in the description, that the fever 
was usually remittent, the paroxysms occurring in the after 
part of the day. This would indicate the employment of 
Quinia, but we do not find that it has been generally adopted. 
At this stage of the affection I invariably give Quinia, unless 
there are symptoms contra-indicating it. The old formula, #, 
Quinia Sulphas, gr. xx; Ferri-ferrocyanuretum, grs. x; M, F., 
Pubis, ~No. vj.. two or three of the powders to be taken in the 
forenoon, at intervals of three hours. This usually arrests 
the fever, and consequently modifies the inflammation. The 
employment of the saline diuretics should not be over- 
looked ; it is true they are not expectorants, but they do what 
expectorants do not — remove the products of inflammation 
in a natural manner. During the second stage the nauseant ex- 
pectorants will sometimes have to be continued, to prevent the 
arrest of the secretion, and to quiet the cough. Occasionally 
expectoration being too free, stimulant expectorants will have 
to replace them, as #, Syrup of Senega, Syrup of Tolu, Cam- 
phorated Tincture of Opium, aa, 3ij; dose a teaspoonful every 
two or three hours. Or, an infusion of equal parts of Senega 
and Trillium, or #, Syrup of Squills, Essl. Tincture of Ascle- 
pias, aa, 3ij ; Syrup of Sanguinaria, 3J ; M., and give a tea- 
spoonful every three hours. 

In the severe cases named, the treatment must be prompt 
and thorough. Wet cups to the thorax, followed by hot 
fomentations, stimulant applications to the surface and espe- 
cially the extremities, with the nauseant expectorants combin- 
ed with stimulants internally, are the means generally pursued ; 
I prefer the emetic, and would much sooner trust my life to it 
than to any other means. The Acetous Emetic Tincture is the 
best agent, given in tablespoonful doses, with warm Ginger 
tea, every ten minutes, until it operates thoroughly. After- 
wards the other means can be employed. Quinia and stimu- 
lants are useful agents in these cases after the congestion is 
removed, but a sufficient quantity of some special sedative (I 
prefer Aconite), must be given to prevent undue rapidity of 
the circulation. 

The treatment of asthenic bronchitis differs very materially 
from the other forms; the feeble condition of the system, 
imperfect circulation, and relaxation of the bronchial mucous 
membrane, must be taken into consideration. In the milder 



Chronic Bronchitis. 123 

cases, the administration of stimulant expectorants, with Qui- 
nia and stimulants, thorough measures to produce an equal 
circulation of blood and thus prevent congestion of the lungs, 
are the principal means of cure. As an expectorant in these 
cases : #, Acetous Emetic Tincture, Syrup of Squills, Syrup of 
Senega, aa ; to be administered in tea-spoonful doses every two, 
three or four hours. The formula of Dr. Stokes answers well 
in some cases — fy, Decoct. Polygala, 3v; Syrup, Tolut, 3ss; 
Tinct. Opii Camph., Tinct. Scillse, aa. 3ij ; Carb. Ammonia, 
gr. xx ; M. ; dose, a tablespoonful every two hours. The Asa- 
rum Canadense will be found a good agent in these cases, as 
will also the Achillea and Trillium; or#, Oil of Stillingia, 3ss; 
Alcohol, gij; Essl. Tinct. Achillea, gij; M; dose, one third 
of a teaspoonful every two or three hours, in Mucilage of Gum 
Arabic. 

Dry cups to the thorax, followed by the Comp. Stillingia 
Liniment will prove valuable; or if a child, a cotton cloth 
large enough to cover the breast spread with Lard, and the 
Emetic Powder sprinkled on it and applied to the thorax. 
Stimulant baths can not be dispensed with ; I employ Tinct. 
of Capsicum and water, sufficiently strong to produce an 
agreeable warmth of the surface, and stimulate normal capil- 
lary circulation. Quinia proves very useful given in the 
early part of the day, especially if there are evening exacer- 
bations. 

In the severe cases I prefer to commence the treatment with 
an emetic ; the Comp. Powd. of Lobelia and Capsicum answers 
well. It should be given so as to produce prompt and thor- 
ough emesis, and repeated as often as the condition of the 
patient demands it. The treatment named above may then 
be pursued. Inhalations prove servicable in this disease, I 
generally employ the vapor of Vinegar, with the addition of 
Morphia if the irritation inducing the cough is severe, or 
Nitrate of Potassa if there seems to be spasm of the bronchial 
tubes. 



CHRONIC BRONCHITIS. 

Chronic inflammation of the bronchial mucous membrane is 
of frequent occurrence and may result from many causes. A 
badly treated acute bronchitis may terminate in the chronic 
form, or an inflammation of the lungs may set up a subacute 



124 The Eclectic Practice of Medicine. 

bronchitis which will continue after the original disease has 
subsided. The most frequent cause is doubtless the neglect 
of catarrhal bronchitis ; the acute symptoms ceasing, the patient 
pays but little attention to the cough, and the persistent 
chronic disease is the result. In many cases the progress of 
the disease is slow and insidious, in others quite rapid. In the 
first case the patient is troubled with cough during the winter 
and spring months whenever exposed to the cold, but which 
passes away with the return of warm weather. The next 
winter he seems to catch cold easier, and the cough is more 
persistent, and does not entirely disappear during the summer. 
With the return of cold changeable weather all the symptoms 
are aggravated, and the general health suffers, the disease 
being permanent. Thus one, two, or more years may be 
required for its development; in other cases, it follows "the 
cold in the chest," or the acute attack. 

Symptoms. — In chronic bronchitis, we have both local and 
general symptoms. Cough seems to be at once the most char- 
acteristic as well as troublesome feature. The cough is per- 
sistent and annoying, generally of a deep bronchial character, 
but sometimes short and hacking, at others asthmatic. It is 
dry or moist, depending upon the amount of secretion from 
the bronchial mucous membrane. Sometimes it is attended 
by a dull, heavy, aching pain or sense of soreness on coughing. 
At others the chest is entirely free from pain. 

Expectoration varies greatly as regards quantity and appear- 
ance. Sometimes it is very scanty, the cough being dry and 
harsh; at others there does not seem to be any great accumu- 
lation in the bronchial tubes, though expectoration in moderate 
quantity attends each paroxysm or cough ; lastly, we observe 
cases in which expectoration is profuse, the patient being 
obliged to cough to remove the accumulations from the chest. 
We thus divide chronic bronchitis into two marked varieties: 
bronchitis with deficient secretion and bronchitis with profuse secre- 
tion. The material expectorated varies from a thin, transparent, 
adhesive mucus, to a yellowish or greenish opaque mucus or 
muco-pus, of a more or less offensive character. 

The physical signs are marked; on applying the ear to the 
chest we find that the normal respiratory sounds are masked 
by those developed in the bronchial tubes. It will be recol- 
lected that bronchial sounds are only heard in the normal 
condition of the respiratory organs, over the larger bronchial 



Chronic Bronchitis. 125 

tubes between the scapula, and that th eir development over other 
portions of the thorax is indicative of disease. To determine 
whether it is the result of solidification of the lungs, or of 
morbid changes in the bronchial tubes, we resort to percus- 
sion; if there is dullness, it depends, at least to considerable 
extent upon solidification, if there is normal resonance, of 
course the cause must exist in the bronchial tubes alone. The 
character of the sound determines to some extent the condi- 
tion of the mucous membrane ; thus a sibilant rhoncus being 
heard, we know there is deficient secretion, and that the dry- 
ness is marked by the degree of whistling in the respiration; 
if a mucous rhoncus is heard, that secretion is established, and 
in proportion to the amount of gurgling ; a deep gurgling or 
flapping sound, that there is great relaxation and atony of the 
mucous membrane. 

The general symptoms vary greatly in different cases ; some- 
times the disease continues for years, and seems to exert but 
little influence upon the health of the patient, but sooner or 
later the patient loses flesh and strength, and the various 
functions are disordered. Generally, when chronic bronchitis 
is established, it is observed that the patient becomes anaBmic, 
the appetite is impaired, the circulation deranged, and the 
secretions unfavorably affected. The disease progressing, the 
loss of strength and flesh is marked, the patient is unable to 
follow his usual employment, his spirits are depressed, and he 
gradually sinks, or tubercules of the lungs are developed, and 
he dies of consumption. 

Diagnosis. — We have to diagnose chronic bronchitis from 
chronic laryngitis and phthisis. In the first we have the well 
marked bronchial sounds, either sibilant or mucous, developed 
over all or a considerable part of the thorax; in the second 
no such sound exists, but instead we have the morbid sensa- 
tions, soreness and pain confined to the larynx; in the third, 
the bronchial sounds are absent, or, if present, are accompan- 
ied with dullness on percussion, especially marked over the 
upper lobes of the lungs. 

Prognosis. — The prognosis may be considered favorable 
unless the disease has progressed too long, or there is profuse 
secretion, with great relaxation and debility; in this case our 
prognosis should be guarded. 

Post-Mortem Examination. — Usually the mucous membrane 
presents a livid, violet colored or brownish tint, instead of the 



126 The Eclectic Practice of Medicine. 

light redness of the acute disease. The other changes are 
thickening of the mucous membrane, ulceration, softening 
and dilatation of the bronchi. The changes in other portions 
of the body will be dependent upon the complications preced- 
ing death. 

Treatment. — The treatment of chronic bronchitis may be 
properly divided into general and local, and as much import- 
ance attaches to the one as the other, of course the general 
treatment will have to be varied according to the complica- 
tions; but the following points deserve especial attention. 
The appetite and digestion being frequently impaired, it is 
necessary to administer such mild tonics as improve the tone 
of the digestive apparatus, and at the same time improve the 
quality of the blood. Frequently these can be selected with 
reference to their action, either direct or indirect, on the pul- 
monary mucous membrane. The bitter tonics, the mineral 
acids, Hypophosphites and K~ux Vomica, are found important 
curative means. The excretions must be restored, and to 
accomplish this the milder agents are of greatest utility. The 
bowels being constipated, mild laxatives are indicated. The 
secretion of the kidneys affected, those agents termed altera- 
tives, that are known to facilitate this secretion, are the best 
adapted. The skin demands our especial attention, from the 
intimate sympathy existing between this membrane and the 
mucous lining of the body. If it is dry and harsh, the use of 
the alkaline sponge-bath, with brisk friction, seems to be of 
much benefit; if there is imperfect capillary circulation, with 
coldness of the extremities, the Capsicum bath is important; 
and if there is much relaxation, the addition of an infusion 
of some bitter tonic, or astringent. Iron is useful in cases of 
anaemia or imperfect nutrition, the Hypophosphites, Sulphur? 
and Quinia, when there is deficient innervation, and STux 
Vomica or other permanent stimulants when the patient 
exhibits an apathy not accounted for by the symptoms of 
the disease. 

Those cases in which the expectoration is scanty, or in 
which the cough is dry and harsh, are benefited usually by 
the employment of the nauseant expectorants, to increase 
secretion. The Lobelia, Sanguinaria, Ipecacuanha, etc., can 
be employed for this purpose with advantage,, and it is gener- 
ally a good plan to combine with them a demulcent to relieve 
the dryness and irritation of the throat and fauces, and a nar- 






Chronic Bronchitis. 127 

cotic to allay the morbid irritation of the nervous system: 
thus, #, Tincture of Lobelia, 3j ; Mucilage of Convallaria, 
gij ; Syrup of Lemon, 3j ; Extract of Belladonna, gr. x, vel, 
Hyoscyamus, gr. xx; M.; dose, a teaspoonful every one or 
two hours. Inhalations of the vapor of Water, or equal parts 
of Water and Vinegar, is of much advantage in many cases, 
and, if need be, a narcotic or sedative can be added to assist 
in arresting the cough. It has been argued by some that the 
vapor might be rendered emollient by using, instead of sim- 
ple Water, a decoction of Marsh Mallows or Linseed ; or both 
emollient and sedative, by using an infusion of Hops, Hyos- 
cyamus, Stramonium, etc. 

Very great advantage is derived from the use of judicious 
counter-irritation to the chest in all cases of this disease, when 
the patient's strength will permit. The most efficient agent 
is the Irritating Plaster of the Dispensatory, though it need 
not, in a majority of cases, be carried to suppuration. 

In those cases in which there is constant expectoration, 
though not profuse, the main object is undoubtedly to relieve 
the irritation and arrest the cough, and by the general medi- 
cation remove the effects of the disease. For the relief of the 
cough numerous remedies have been advised. The nauseant 
expectorants are still employed in this case, though in smaller 
doses. As an example of such combination, I may instance 
the Compound Syrup of Lobelia, described on page 677, Materia 
Medica, and the first six formulas in the Appendix, page 954; 
or we use them combined with the stimulant expectorants, 
as, #, Syrup of Lobelia, Syrup of Senega, Syrup of Althaea, 
aa, 3ij; Tincture of Hyoscyamus, 3ss; M. ; dose, a teaspoon- 
ful every two hours. We may dispense with nauseants 
entirely, and depend upon demulcents and narcotics or seda- 
tives for the relief of irritation and arrest of the cough, as in 
the old formula: #, Pulverized Acacioe, 3ij ; Mist. Amygdal. 
Dulc. et Mist. Camphores, aa, 3ijss; Acid Hydrocyanica, gtt. 
xij; Spir. JEther, Snip. Camphor, 3ij ; Oymellis Scilhe, 3ss; M; 
dose, a teasponful every two or three hours. Inhalations are 
employed in these cases with advantage; usually the simple 
vapor of Water and Vinegar, or medicated with the narcotics 
or sedatives to allay irritation, are the ones giving the best 
results. As examples of sedative inhalations: #, Acid Hydro- 
cyanici, f3ij ; Vinum Ipecac, Tinctura Opii Camphorata, aa, 
fSss; Tinctura Conii, fgij; Aquai Rosa?, Sxij; M. ; inhale 



128 The Eclectic Practice of Medicine. 

half an ounce three times a day; or, #, Acetum Lobelia?, 
f3ij; Tinctura Conii, Tinctura Stramonise, aa, 3 j ; Tinctura 
Opii, f3ss; Cyanuret of Potassse, gr. x; M.; a half teaspoon- 
ful may be added to half an ounce of Barley Water, and 
inhaled every three hours. I have also employed the Com- 
pound Tincture of Oils of Lobelia and Stillingia in this way, 
a few drops being poured into a vessel of boiling Water, and 
the vapor inhaled. 

When the expectoration is profuse, stimulant expectorants 
are usually employed. In this class we find the Senega, Squills 
and some other agents, and the balsamic expectorants. I 
have used in this, as well as the other cases, the Compound 
Tincture of Oil of Lobelia, heretofore named, with marked 
advantage for the relief of the cough. It should be adminis- 
tered in drop doses every three or four hours on a lump of 
sugar. To arrest the secretion, I am using a new class of 
agents: they are the Collinsonia Achillea, Ptelea, Trillium, 
Lycopus, Polygonum, and Euonymus, usually in the form of 
essential tinctures. The first three I have found very effi- 
cient, acting as gentle tonics and stimulants, improving the 
appetite and digestion, restoring the excretions, and, at the 
same time, relieving the irritation of the pulmonary mucous 
membrane. The Trillium is a fine agent when the secretion 
is excessive, the Polygonum when there is torpid circulation 
of blood, and dryness of the skin, and the Euonymus in cases 
where hectic fever and night-sweats are developed. The bal- 
samic expectorants are employed in many combinations, as, 
#, Balsam of Fir, Balsam of Tolu, Balsam of Peru, aa, 3 j ; 
Oil of Anise, 3ss; Opium, 3 j ; Honey, 3ij: Rum (best Ja- 
maica), Oj; mix, shake well, and take one or two teaspoon- 
fuls every three or four hours. Balsam of Copaiba has been 
employed with advantage, as, #, Copaiba, 3j ; Balsam of Eir, 
Sweet Spirits of Mtre, Honey, aa, 3ss; M. ; dose, a teaspoon- 
ful three or four times a day, in simple Syrup, or in mucillage 
of Gum Arabic. 

Stimulant inhalations are sometimes of benefit in these 
cases; among the agents used for this purpose, may be named 
the expectorant gum resins, Tar, Creosote, Myrrh, Ammonia, 
Iodine, Chlorine, Bromine, infusion of Podophyllin, Iris, 
Sanguinaria, Xanthoxylum, etc. Care must be used in the 
employment of these agents, that they do not give rise to irri- 



Pneumonia. 129 



tation, and that they are so largely mixed with air, as not to 
interfere with respiration. 



p;n t eumoin t ia. 

Inflammation of the parenchyma of the lungs is a disease 
of frequent occurrence, and involving, as it does, so important 
a structure, its effect upon the general system is proportion- 
ately severe. The extent of the inflammation varies in differ- 
ent cases; sometimes but a portion of one lung is involved^ 
at others, one entire lung, and lastly, both lungs may be 
involved in the disease. If the inflammation is confined to 
one lung, it is termed single, if it affects both, double pneu- 
monia, the last being a very severe disease. 

Pneumonia is, in a large majority of cases, produced by 
cold; in the exceptional cases by irritant materials inhaled, or 
as the result of injury. The action of .cold upon the system, 
and its influence in producing disease, has been already con- 
sidered, and it is only necessary to notice here that previous 
exhaustion, and sudden arrest of the cutaneous secretion, are 
almost invariably noticed. 

Symptoms. — Generally the disease is preceded for a day or 
two by premonitory symptoms, as, oppression of the chest, 
quickness and shortness of breathing, quick, short cough, dull- 
ness and languor, occasional sighing, and more or less chilly 
sensations and coldness of the extremities. The inflammation 
is usually ushered in by marked chills or rigors, continuing 
from one to two or more hours. There is now an increase of 
the symptoms before named, general uneasiness, and a dry 
and suppressed cough. With the disappearance of the chill, 
febrile reaction comes up, the pulse is frequent and hard, the 
skin dry and hot, appetite impaired, tongue coated white, 
bowels constipated, and urine scanty. Respiration is more 
short, frequent, anxious and difficult, and attended with 
unusual expansion and elevation of the chest; there is a fre- 
quent short cough, and increased warmth and moisture of the 
expired air. Upon auscultation we find that the respiratory 
murmur is replaced by the crepitant rhoncus, there is no bron- 
chial sound, and no dullness on percussion. During this period 
the cough has been dry, or, if any expectoration, it is thin, 
transparent, or frothy. 

By the third or fourth day, we find that the patient is 
10 



180 The Eclectic Practice of Medicine. 

unable to take a deep inspiration, respiration being performed 
principally by the diaphragm and abdominal muscles. He lies 
in preference upon the affected side, or, in double pneumonia, 
upon the back. There is a constant feeling of uneasiness 
rather than pain in the chest, with anxiety, sense of constric- 
tion, weight and fullness, and of internal heat. In some cases 
there is constant restlessness, with frequent attempts to ele- 
vate the head and shoulders. Now, the crepitant rhoncus dis- 
appears, and is replaced by a mucous rhoncus; percussion gives 
increasing dullness over that portion of the lungs involved in 
the inflammation. This indicates hepatization, which, increas- 
ing, gives rise to extreme dullness on percussion, and to a 
remarkable clearness of the bronchial sound, and to bronco- 
phony. 

The cough, which has generally increased up to this time, is 
now attended with expectoration of an opaque mucus, which 
becomes characteristic about the fifth or sixth day. The 
sputa is of a yellowish, reddish, or more frequently, rusty tinge, 
semi-transparent, tenacious and globular; when discharged 
into a vessel, it runs together, forming a single mass, so tena- 
cious that the vessel may be inverted without detaching it. 
The rusty sputa has been considered as pathognomonic of pneu- 
monia. 

By this time the dyspnoea is much increased, the inspira- 
tions being obviously short and quick. If the disease is exten- 
sive, the oppression becomes urgent, and the sense of weight 
and anxiety are extreme. . About the fifth or sixth day in 
favorable cases, the disease commences to decline, the inflam- 
mation terminating by resolution. The cough becomes looser 
and less distressing. The expectoration less viscid and rusty- 
colored and more abundant, resembling the sputa of bronchitis, 
the pain and dyspnoea are gradually relieved, the febrile symp- 
toms disappear, and the patient is convalescent at about the 
seventh to the ninth day of the disease. 

Otherwise, the hepatization goes on, the dyspnoea is increased, 
and so urgent is the call for breath, where a large portion of 
the lung is involved, that the patient has to have the head and 
shoulders raised, and call into action the external inspira- 
tory muscles. The inspirations are short, forced and rapid, 
sometimes from 40 to 60 per minute. The cough is persistent 
and extremely annoying, the viscidity and color of the sputa 
corresponding to the intensity of the disease. The general 



Pneumonia, 181 

symptoms correspond with the local, the pulse is increased in fre- 
quency to 120 or even 140 beats per minute, and is small and hard, 
cr soft and fluent; the skin is hot, dry and rough; the tongue 
is heavily coated with a brownish, offensive mucus, which 
becomes darker as the disease advances, sordes appearing 
around the teeth. The patient becomes delirious, at first but 
partially and for a portion of the day, but finally it becomes 
continuous, and sinks into a low, muttering delirium or into 
coma. The symptoms above named, extend over a period of 
one or two weeks, sometimes coming on rapidly, in others 
very slowly ; the disease terminating fatally in some by the 
twelfth day, in others in three or four weeks, or the patient 
recovers after this, having worn the disease out. 

In the suppurative stsge, or stage of gray hepatization, the 
symptoms are all asthenic. The sputa is either a purplish-red 
mucosity, or a homogenous, light, yellow-colored purulent 
matter, of the consistence of cream, or a prune-juice-like mate- 
rial. The physical signs are, intense dullness on percussion, 
and a muco-crepitant sound on auscultation, very distinctive 
in character. 

PI euro -Pneumonia. — The symptoms of pleuro-pneumonia 
differ from pneumonia proper in little more than the develop- 
ment of pain, and consequent increased difficulty of respira- 
tion. The pleuritic combination is seldom so severe as to 
increase the intensity or danger of the principal affection. 
Rarely we find a case in which an intense inflammation of the 
pleura and lung occur together, producing a very serious affec- 
tion, the symptoms being then of an acute pleurisy, followed 
by those of pneumonia. 

Typhoid Pneumonia. — It might be supposed that what is 
termed typhoid pneumonia should receive an extended descrip- 
tion ; I am of the opinion, however, that 90 per cent of these 
cases are those heretofore spoken of as typhoid fever with 
pneumonic complication, or badly treated cases of ordinary 
pneumonia. I have already given it as my opinion that any 
fever may run into a slow ataxic or typhoid fever, so may an 
inflammation with its accompanying fever. We have a class 
of cases, however, that might properly be termed typhoid, 
inasmuch as the symptoms are all indicative of feeble vitality, 
and there is rapid change in the constitution of the blood. 

The symptoms in these cases are : a protracted chill, febrile 
reaction coming up slowly ; the pulse frequent, soft and fluent ; 



132 The Eclectic Practice of Medicine. 

heat of the surface not greater than natural ; coldness of extremi- 
ties; howels easily acted upon or tendency to diarrhoea; lim- 
pid, frothy urine ; dirty coating of the tongue ; and especially 
that dullness and indifference so characteristic of typhoid or 
typhus diseases. The inflammation in this case is ataxic; 
there is difficult breathing and cough, with watery expectora- 
tion. Physical examination gives us rapidly increasing dull- 
ness on percussion to a certain degree, at which point it remains 
sometimes during the entire progress of the disease; there is 
no crepitant rhoncus, and the mucous rhoncus sounds distinct 
and hollow. This condition is of variable duration, sometimes 
the disease is slow and protracted to weeks, at other times it 
is rapidly fatal. 

Diagnosis. — In general the diagnosis of pneumonia is easily 
made, the cough and difficult breathing directs attention to the 
thorax as the seat of the disease, the crepitant rhoncus in the 
first stage, and the mucous rhoncus and dullness on percussion 
and rusty-colored sputa in the second stage, are certain evi- 
dences of the affection. The amelioration of the symptoms 
from the fifth to the seventh day, give evidence of a resolution 
and subsidence of the disease ; the aggravation of the general 
symptoms, with increased dullness on percussion and difficulty 
of respiration, that the structure of the lung is being endan- 
gered. The prune-juice expectoration, or light-colored puru- 
lent sputa that the structure of the lung is breaking down. 

Prognosis. — We may anticipate a favorable termination in a 
large majority of cases. In fact, we do not consider any dan- 
gerous, unless both lungs are affected, or typhoid symptoms 
are manifested from the commencement. In a majority of 
cases the disease can be arrested before there is much exuda- 
tion into the structure of the lung, and consequently all dan- 
ger avoided. 

Post-Mortem Examination. — In the early stage of the 
disease, the density of the lungs is slightly increased, they are 
reddened, and exhibit evidence of determination of blood. 
In the stage of hepatization, the density of the lung is so 
great that it sinks in water ; if an incision is made into it, the 
cut surfaces vary from a pinkish-brown to a reddish-gray color, 
with sometimes more or less black pulmonary matter, or nu- 
merous little points of lighter color than the lung itself. The 
solidification appears to be dependent in part upon the exuda- 
tion of coagulated lymph, but principally on an engorgement 



Pneumonia. 133 

of the lung with blood. In the stage of gray hepatization or 
Interstitial suppuration, the lung is still dense, and where an 
incision is made into it, seems to be mottled with yellow; 
pressure applied to the lung when thus incised causes an exu- 
dation of yellowish, purulent matter from the cut surface. 

Treatment. — As before remarked, I am satisfied that pneu- 
monia can be arrested in its early stage, before hepatization 
has commenced, and all danger to the structure of the lungs 
thus avoided. The treatment for the accomplishment of this 
object must of course be resorted to early in the disease. Sev- 
eral plans of treatment may be pursued, as we found to be the 
case in the treatment of acute bronchitis, the indications being 
to effect sedation, and establish excretion, which being accom- 
plished, an acute inflammatory action can not go on. I 
generally employ the direct sedatives, as, #, Tincture Vera- 
trum, f3j ; Tincture Aconite, f3ss ; Essl. Tincture Asclepias, 
ftj ; Aqua, 3v; M., and give a teaspoonful every hour, or in 
severe cases every half-hour, until the fever abates. If the 
inflammation is sthenic, I administer a mild cathartic to 
induce one or two evaeutions from the bowels. As adj uvants to 
the above, I direct the frequent use of the sponge bath, the 
hot Mustard foot bath, and hot fomentations to the chest. 
Previously to the employment of the fomentations, I use the 
cups, wet or dry, if the case is severe. On the second day, I 
add Acetate of Potassa to the treatment, and at night admin- 
ister a full dose of Opium or Morphia. In nine cases out of 
ten, the third day finds the patient almost free from fever, and 
ready for the employment of Quinia to the extent of ten 
grains daily. This would seem to be a very simple treatment, 
and at the same time promises more than can reasonably be 
expected ; but if we examine the treatment, it is only simple 
by being explicit; the sedatives are powerful, and they are 
given in quantities sufficient to produce sedation in twenty- 
four hours, and almost always by the end of the third day ; 
secretion is provided for by way of the skin, kidneys and 
bowels; sleep is induced, and the integrity of the nervous 
system restored by the employment of Quinia. 

Indirect sedatives can be used in place of the direct, though 
their administration and action is not so pleasant. Thus, we 
may use the spirit vapor bath with the administration of a 
warm infusion of Eupatorium and Compound Tincture of Vir- 
ginia Snakeroot, at the same time using the cups to the seat 



134 The Eclectic Practice of Medicine. 

of inflammation, and following with hot fomentations. Follow- 
ing the bath the patient should be placed in bed, and perspira- 
tion should be continued by warm applications to the surface, 
and the administration of nauseant diaphoretics and expecto- 
rants ; the bowels might be freely moved, the diuretic Salts of 
Potassa administered, sleep induced, and when the secretions 
were established, Quinia would naturally follow. Or, we might 
substitute for the vapor bath an old-fashioned thorough emetic; 
or if hydropathieally inclined, put the patient in the wet sheet. 

There are some things in this treatment worthy of separate 
notice. First, the sedative acts better when employed in small 
and frequently repeated doses, and should be continued until 
convalescence is established; a great mistake, in my opinion, 
is committed by suspending it as soon as the pulse is reduced 
in frequency ; for in a majority of cases if so suspended, the 
pulse will again become frequent. Second, I attribute much 
of the success to the use of the saline diuretic; in many cases, 
it seems to give prompt and effectual relief. Third, the full 
dose of Opium or Morphia as soon as excretion lias com- 
menced, is attended with the happiest results, and allays 
irritation, checks the cough, facilitates the action of the other 
remedies, and acts as a powerful restorative by giving tempo- 
rary rest to the nervous system. 

We not unfrequently meet with cases in which the irritation 
of the respiratory organs is so great, as to keep up a constant 
harrassing cough to the great injury of the patient. In such 
case our remedies do not exercise their usual influence over 
the disease, until the irritation is subdued. To accomplish 
this, the nauseant expectorants heretofore named, may be 
employed in doses just sufficient to continue slight nausea ; in 
addition to the means heretofore named, a moist atmosphere 
is of the utmost importance in these cases, and frequently it 
will be of advantage to let the patient inhale the vapor of 
water. Counter-irritation should be perseveringly employed. 
I employ cups and hot fomentations as heretofore named, but 
many prefer the blister. 

In cases of double pneumonia, the emetic is, in my opinion, 
preferable to all other treatment at the commencement. 1 
use the Compound Powder of Lobelia, or Acetous Emetic 
Tincture, given so as to produce nausea for an hour or so, and 
then carried to thorough emesis. The emetic should be fol- 
lowed by warm diaphoretic infusions, with a nauseant expect- 



Pneumonia. 135 

orant, aided by the hot foot bath, and hot fomentations to the 
chest. The emetic may be repeated in twenty-four hours, if 
thought necessary, but usually the treatment first named will 
be sufficient. 

In typhoid pneumonia, where the loss of strength and 
congestion of the lungs are marked, the emetic will also be 
found to produce a favorable influence. It should, however, 
be speedy and thorough in its action, the nausea not being 
prolonged. Following it we adopt the treatment recommended 
in typhoid fever, with the additional measures for promoting 
expectoration, and relieving inflammation. Patients suffering 
from typhoid pneumonia usually bear stimulants well, and 
should have as much as the system will appropriate without 
increasiug the action of the pulse ; care must be used to avoid 
everything that tends to depress the powers of life. 

The treatment of pleuro-pneumonia will not differ mate- 
rially from that named for pleurisy, for the^ first day or two. 
If the pain is acute, the spirit vapor bath, with the stronger 
diaphoretics, cups to the thorax, followed by hot fomentations, 
is the appropriate treatment. After the first twenty-four 
hours, the treatment will be that proper for pneumonia un- 
complicated. 



CHKOOTC PIsTEUMOOTA. 

Chronic inflammation of the lungs is not a common disease, 
and yet it occurs sufficiently often to make it an interesting- 
subject of study. It is said to be the result of acute pneu- 
monia by many authorities, and doubtless this is the case 
many times, but I have good reason to believe that in quite a 
number it results from a sub-acute inflammation that has not 
been sufficiently intense to prostrate the patient; it also 
results in some cases from organic lesion of the heart. 
When the result of acute pneumonia, it is observed that the 
patient does not fully recover from the acute attack, but is 
still troubled with symptoms indicative of imperfect respira- 
tory action. In the second case, it comes on gradually, follow- 
ing a severe cold, the symptoms, both local and constitutional, 
becoming more and more marked as the structure of the lung 
becomes affected. In the third case, it usually comes on 
slowly from imperfect circulation of blood in the lungs. 

Symptoms. — Among the most prominent local symptoms are 



136 Diseases of the Bespiratory Apparatus. 

cough, dyspnoea, or oppression of breath and quickness of 
respiration. The cough varies greatly, sometimes coming on 
at frequent intervals, deep, hard and harrassing, at others 
short and hacking, or deep and more or less hollow; occasion- 
ally the patient coughs more in the evening on going to bed 
and in the morning on arising, than at other times, as in 
phthisis. Usually there is more or less mucus expectoration, 
though sometimes the cough is constantly dry ; occasionally 
the matter thrown off is purulent and in considerable quan- 
tities, from the breaking down of portions of the hepatized 
lung. The dyspnoea is proportionate to the extent of the 
inflammation, though always increased by exertion. 

The general symptoms are those of depression ; there is 
loss of strength and flesh ; the appetite is impaired and diges- 
tion imperfect; the bowels at first constipated, at last become 
irregular; the skin is either dry and harsh, or soft, relaxed 
and flabby; in either case failing to perform its functions. If 
the disease is severe, the patient seems to have an intractable 
intermittent fever, the chill coming on in the afternoon or 
evening, followed by hectic fever, and it by exhausting night 
sweats. As the disease progresses, these symptoms become 
worse, the patient is reduced to a skeleton, he has just suffi- 
cient strength to walk around, finally becoming bed-fast, he 
soon sinks. A very marked resemblance to phthisis, both in 
the general and local symptoms will be noticed, so that it is 
very difficult, if not impossible in some cases, to determine 
the difficulty. 

We rarely have an opportunity of making a physical exam- 
ination in the early stage of the disease, the patient applying 
for assistance only when the disease has produced the severe 
general symptoms above named. At this time we will find mark- 
ed dullness on percussion over the seat of the disease, which 
most generally is situate in the middle or inferior lobes of the 
lungs, and not at the apex as in phthisis. Auscultation gives 
us a marked mucus rhoncus and broncophony ; occasionally a 
crepitant rhoncus is heard at the outside of the dullness, 
which would indicate a more acute case, and spread of the 
inflammation, unless the symptoms were abating, when it 
would be taken as a sign of resolution. 

Diagnosis. — We distinguish chronic inflammation of the 
lungs from phthisis, first, by the extensive dullness compared 
with the general symptoms ; second, by its being situate in 



Pneumonia. 137 

the middle or inferior lobes, rather than in the apex of the 
lungs; and, third, by the absence of any hereditary ten- 
dency to consumption. 

Prognosis. — The prognosis will be favorable in probably one- 
half the cases. The previous good health of the patient, the 
absence of any hereditary tendency to disease of the lungs, 
and still sufficient strength to take exercise in the open air, 
may be considered favorable, whilst the reverse would be con- 
sidered unfavorable. 

Post-Mortem Examination. — According to Copland "The 
gray induration constituting the more simple form of the 
disease varies in its aspect like acute hepatization, accord- 
ing to the tissues chiefly affected. It may thus assume a 
granular or oolitic aspect, owing to the thickening of indi- 
vidual vesicles. In some cases, it appears streaked and veined 
from the hypertrophy of the interlobular septa and cellular 
tissue around the vessels ; in others it is more uniform and 
darker in color. In this variety, the cellular tissue between 
the lobules is sometimes thickened to the extent of several lines, 
and is of a light drab or gray color, like that of miliary granu- 
lations, and like those has almost the density of cartilage." 

Treatment. — A very careful examination of the patient, as 
regards the general symptoms, is necessary in order to obtain 
the best results from medicine. For instance, if the bowels 
are not irritable, we can put our patient upon small doses of 
Podophyllin, with one of the diuretic Salts of Potassa, in addi- 
tion to the expectorants indicated by the symptoms, and in 
some cases we thus get a rapid removal of the efusion. Unfor- 
tunately we find this rarely to be the case, and we have to 
resort to other means. 

Tonic expectorants, combined with alteratives, answer a 
good purpose, as, #, Tincture of Ptelea, Tincture of Achillea, 
Tincture of Collinsonia, aa, 3j ; Syrup of Senega, 3ii ; M., and 
give in teaspoonful doses every three or four hours. An infu- 
sion of Alnus Senulata and Trillium, sweetened with Honey, 
and if desired acidulated with Lemon juice, answers a good 
purpose to check the cough and increase the secretions. 

Lobelia and Sanguinaria answer a good purpose as expecto- 
rants in some cases, but usually they can not be employed on 
account of the derangement of the stomach they produce. In 
cases, therefore, where the action of a nauseant is desired, it 
is better to use them once or twice, or three times a week to 



138 The Eclectic Practice of Medicine. 

produce free emesis. When the patient can bear the action, 
there is no means so certain or speedy. 

The diuretic salts have been named as appropriate in this 
affection, but often they can not be used on account of disturb- 
ing the bowels. Hence, the Chlorate of Potassa, or the Iodide 
of Potassium, with occasionally a mild vegetable diuretic, will 
be found of advantage. I have sometimes used, in these cases 
the Iodine pills made as follows : #, Extract Nux Vomica, 
Iodine, aa, gr. v; Hydrastine, 3ss; Extract of Taraxicum, 3s; 
make 30 pills ; one to be taken three times a day. 

Counter-irritation proves very effective in this disease. If 
the patient is of a robust habit, I direct alternate wet and dry 
cups two or three times a week, followed by the cold Vinegar 
bandage. In other cases, the irritating plaster proves most 
efficient ; if the patient is feeble, it should be used just suffi- 
ciently to produce a crop of small pustules, then removed and 
re-applied when the irritation has disappeared ; in other cases 
it may be used to produce free suppuration. The use of stimu- 
lant and other baths is of the highest importance, for if the 
skin fails to act the entire treatment will fail ; much attention 
must likewise be paid to gcttiug an equal circulation in all 
parts of the system, and for this purpose if there is coldness 
of the extremities, the Tincture of Capsicum lotion heretofore 
named, should be employed. 

Good digestion and highly nutritious diet are very impor- 
tant elements of success, as experience proves that a diseased 
structure acquires its original condition in proportion as the 
blood is rich in the elements for nutrition. Hence, in all of 
these cases a small portion of some judiciously selected tonic 
should form a part of each day's treatment. 



ASTHMA. 

The name of this disease indicates accurately its character : 
" I breathe with difficulty ; " and anything else may be con- 
sidered a complication, as are organic lesions of the respiratory 
apparatus. Copland's definition, " Great difficulty of breath- 
ing, recurring in paroxysms, accompanied with a wheezing 
sound, sense of constriction in the thorax, anxiety and a diffi- 
cult cough, terminating in mucus expectoration," is a very 
complete description. 



Asthma. 139 

Pathology. — It is now generally admitted that asthma is 
purely a nervous affection, the irritation being expended in a 
series of muscular fibers that connect the extremities of the car- 
tilages of the bronchial tubes, forming about one-third of the 
diameter of the air-passage. Any cause that will irritate the 
nerves distributed to this muscular structure, causing more or 
less permanent contraction, produces asthma. 

As regards the cause of the disease, there is a diversity of 
opinion, some attributing it to irritation of the bronchial 
mucous membrane, others to disease of the cerebro-spinal ner- 
vous centers, others again to a lesion of the blood, and others 
to organic disease of the heart. Probably all are correct, as 
we observe that irritation of the mucous membrane from cold 
is frequently the exciting cause ; that the disease is induced by 
excessive emotional excitement, and sometimes comes on dur- 
ing disease of the nervous centers ; that in chronic cases, reme- 
dies directed to the blood, are about the only ones that are 
permanently beneficial ; and that in some forms of heart dis- 
ease, asthma appears as a symptom. 

Dr. Todd concludes: "That asthma is primarily humoral ; 
that it is caused by a poison or morbid matter acting on that 
portion of the nervous system which ministers to the function 
of respiration ; that it leads to dilatation of the lungs and walls 
of the chest, to emphysema, and ultimately to dilatation of the 
heart ; that the habit may pass off, the morbid matter being 
no longer created, the patient ceasing to be asthmatic just as 
a person ceases to be gouty or epileptic; and that, ceasing to 
be asthmatic, the patient may remain, or may not remain, 
emphysematous, according to the severity and duration of his 
previous attacks. 

Symptoms. — The symptoms of asthma are so marked that an 
extended description is unnecessary. In some cases the attack 
is preceded for a day or more by a loaded tongue, some pain 
and weight in the head, and a feeling of languor, but in others 
there are no premonitory symptoms. The disease js sudden 
in its onset, the patient being aroused at night by a feeling of 
impending suffocation or forced to throw open the windows 
and doors in order to get breath. Usually it comes on gradu- 
ally, attaining its greatest violence in two, three or four days, 
and as gradually disappearing. We find a patient suffering 
from an attack of asthma with the head and shoulders raised 
and thrown forward, the breathing remarkably difficult, 



140 The Eclectic Practice of Medicine. 

wheezy, laborious and prolonged, and anxiety and evidence of 
imperfect aeration of the blood, proportioned to the severity 
of the disease. 

Sometimes there is markedly increased secretion, the air- 
passages seeming to be loaded with mucus, at others the respi- 
ration is shrill and whistling. Cough is present in nearly all 
cases, sometimes very severe, and prolonged, giving rise to 
very great difficulty of breathing, and aggravating the patient's 
suffering, at others short, and occurring at unfrequent intervals. 

The duration of the paroxysms is very variable, sometimes 
but a few hours, at others, days or even weeks. Their recur- 
rence, too, varies greatly even in the same cases; in some the 
patient is hardly free from the disease from autumn until sum- 
mer. Rare cases are met with in which the one attack having 
been arrested, the patient is not predisposed to its recurrence, 
but in a large majority the disease becomes constitutional, and 
an attack of asthma is the result of any indiscretion, or sudden 
change of weather. 

Diagnosis. — The difficult breathing, with absence of febrile 
symptoms, is sufficient to determine the character of the 
affection, if not, the previous character of the patient will 
make the case plain. 

Prognosis. — Though not classed among those diseases likely 
to prove fatal, it occasionally terminates the life of the patient 
speedily. In these cases, there is usually some organic affec- 
tion of the heart. It is a very difficult disease to cure radi- 
cally, and possibly in one-half the cases we meet, if confirmed, 
the treatment will be merely palliative. 

Treatment. — The treatment of asthma may appropriately 
be divided into palliative and permanent, the first having 
reference to mitigating or arresting the paroxysm, the second 
to the removal of the cause. 

Palliative Treatment. — Lobelia is considered by all schools as 
standing at the head of remedies of this class, and is frequently 
useful. It may be employed in the form of the Tincture, in 
doses of half a teaspoonful to one teaspoonful every one or 
two hours, until nausea is induced ; or better, make an infusion 
of the Emetic Powder, and administer to induce free emesis, 
afterwards in smaller doses to keep up the effect. I have em- 
ployed the Comp. Powder of Ipecacuanha and Opium in doses 
of five grains, and Opium with Powdered Lobelia-seed, are 
given with advantage. The herb smoked in a common 



Asthma. 141 

tobacco-pipe, with an equal quantity of Stramonium leaves, is 
highly recommended, as is also the inhalation of the vapor of 
an infusion of both. 

Carbonate of Ammonia added to the preceding prescrip- 
tions has been recommended, as has the Hydrochlorate ; and 
an inhalation of Aqua Ammonia. The Nitrate of Potash is 
one of the best remedies I have seen used : make a saturated 
solution in boiling water, and saturate common brown paper, 
let it dry, and burn it in the patient's room, allowing him to 
inhale the smoke. Another form is to take pasteboard broken 
down in hot water, 3iv; Nitrate of Potash, 3ij ; Belladonna, 
Stramonium, Digitalis, Lobelia Innata, aa in powder, gr. xx ; 
Myrrh and Olibanum, aa, 3ijss; incorporate all these and dry 
thoroughly, when it may be burnt in the patient's room as the 
preceding; or it is formed into cigarets by saturating the 
leaves of Stramonium and Belladonna and with Nitrate of 
Potash. 

Chloroform has been employed to mitigate the paroxysms, 
which it does in many cases very speedily ; twenty to thirty 
drops are inhaled from a handkerchief, and repeated cautious- 
ly. M. Guerard dipped a small piece of charpie into pure 
Liquor Ammonia, and then instantaneously into water, and 
passed into the back of the throat, touching rapidly the pillars 
of the fauces, soft palate and pharynx. He treated over one 
hundred in this way, and seldom had to repeat the operation. 

Dr. L. C. Dolley, in an article on asthma, speaks of using 
a Syrup of Lobelia, Sanguinaria and Ictodes Foatidus, with 
advantage. 

Treatment for a Radical Cure. — Many plans of treatment 
have been recommended for the permanent cure of this dis- 
ease, as well as specific remedies for this purpose, but as yet 
without flattering success. I have used as special agents for 
this purpose, Essl. Tincture of Achillea, Ptelea, Euonymus 
and Collinsonia, aa, in doses of a teaspoonful four times daily 
with marked advantage in some cases, but without any in 
others. The Tincture of the Rosin Root, a variety of the 
Silphium, growing in Illinois, has, so far as we have tried it, 
answered a good purpose, and needs further investigation. 

Considering the disease as one of the blood, a course of 
treatment adapted to free it from its impurities by elimination 
has been adopted with success. Thus, the old formula, "#, 
Sulphr. Prsecip., 3ss; Semin. Anisi. Contus, 3ijss; Confect. 



142 The Eclectic Practice of Medicine. 

Sennse et Syr. Tolut, aa, 3vj ; M." in dose of one or two tea- 
spoonfuls, was very efficient in some cases ; or, as prescribed 
by Dr. Dolley, #, Sulphur 3jss ; Anise Seed, Pulv. 3ss ; Senna 
and Cream of Tartar, Puly. aa, 3j ; M. ; in doses of a teaspoonful 
in Syrup taken at night, or in severe cases, two or three times a 
day. Dr. D. remarks, that "An experience of fifteen years has 
demonstrated to his mind conclusively the virtues of Sulphur." 
He also recommends: #, Tincture Phytolacca, 3iij ; Iodide of 
Potassa, 3i ; Simple Syrup, 3j ; in doses of a teaspoonful three 
times a day. 

Especial attention should be paid to the general health of 
the patient; I have known cases where even temporary 
alleviation could not be obtained, owing to irritation of the 
stomach, and one case radically cured simpty by getting the 
alimentary canal in normal condition, there having been con- 
firmed dyspepsia and obstinate constipation. In another case, 
the disease was materially benefited by the treatment of an 
herpetic disease of the skin, previous to which the surface had 
been rough and harsh and the secretion deficient. 

Bathing is an important element of the treatment, and none 
will prove successful without it. A remarkable liability to 
catch cold is a peculiarity of asthmatics, and this cold proves 
the exciting cause of the disease ; remove the tendency, and 
the paroxysms become less. The only prophylactic that I 
have found, is bathing with cold water ; let the patient com- 
mence with tepid water first, used once a day, and use it cooler 
and cooler, until finally cold water can be employed without 
danger. The addition of salt to the water is advantageous in 
many cases ; and when the disease is severe and the patient 
debilitated, a lotion of Hydrochlorate of Ammonia, 3j ; 
Water, Oj ; applied to the thorax is advantageous. 



EMPHYSEMA. 

Emphysema is the infiltration of air into a part not natural 
to it; or the undue distension of the parenchyma of the lungs 
with air, caused by the rupture of the air-cells. It arises from 
two causes: first, as the result of injury, a communication 
being established between the respiratory apparatus and the 
emphysematous part; and second, by forcible action of the 
lungs, whereby the tissue is ruptured, as in asthma, some 
cases of bronchitis, etc. 



Phthisis Pulmonalis. . 148 

In the first case, the emphysema is usually of the thoracic 
parieties, the cellular tissue being sometimes remarkably dis- 
tended. It is readily determined by the crepitation on per- 
cussion, but it is not so easy sometimes to determine its cause. 

In the second case we find an unnatural resonance on per- 
cussion, and, judging from the physical signs, should expect 
free respiration. But, on the contrary, it is more or less diffi- 
cult, with evidence of imperfect aeration of the blood. The 
accompanying disease gives additional evidence of the diffi- 
culty. 

Treatment. — The treatment of external emphysema will 
have to be adapted to each individual case. If from a wound, 
as soon as the communication between the lungs and the cel- 
lular tissue is cut off the further extension of the emphysema 
will stop: when necessary, owing to extreme distension, free 
incisions have been recommended to remove the air. In 
internal emphysema, a tonic and supporting treatment must 
be adopted; and if the cause is still in operation, it must be 
removed if possible. 



PHTHISIS PITLMOKALIS. 

(consumption.) 

This most insidious and intractable of all diseases of the re- 
spiratory apparatus is of very frequent occurrence, and year by 
year the predisposition to it seems to increase. It demands care- 
ful study, as it is only in its earlier stages that curative treat- 
ment is of any avail ; at a later period all we can do is to pal- 
liate the symptoms as they arise, and smooth the sufferer's 
pathway to the grave. 

Pathology. — The impression that phthisis is a disease of 
the lungs exclusively, is rapidly giving way; and most author- 
ities now recognize a preexistent disease of the blood. It is 
true that we are not able to analyze the vital fluid, and deter- 
mine the changes that give rise to the exudation of tubercle, 
but sufficient evidence exists in the symptoms and character 
of the deposit to warrant the opinion. We hold that previ- 
ous to the commencement of the tuberculous deposit, there 
has been deficient elaboration of the blood, and that, in con- 
sequence of this, there exists in the blood a material of low 
organization, not readily removed by the excretory organs, 
but which may be deposited in any organ or tissue to which 



144 _ The Eclectic Practice of Medicine. 

a determination of blood is set up. Tuberculosis, it will be 
recollected, is not confined to the lungs, but may affect any 
part of the system, the determining cause being, as above 
named, an irritation causing determination of blood. 

The evidence of these views is found, first, in the fact that 
phthisis occurs in families of feeble vitality, and that it is hered- 
itary simply because parents of feeble vitality can not produce 
healthy offspring, the children inheriting the imperfections 
of the parents. In such families, we notice the evidence of 
this, from childhood up to adult age, especially in the dis- 
eases of childhood of which so many die. Second, preceding 
the development of phthisis, we observe a marked depression 
of vitality manifested by a feeble performance of all the func- 
tions of the body, and more or less defect of tonicity. Lastly, 
the only treatment that offers a probability of success is that 
that improves digestion, the elaboration of the blood, nutri- 
tion, and excretion; it is only by raising the vitality above 
the point of tuberculosis that we are able to ward it off or 
arrest it. 

It is not known whether the tuberculous matter is directly 
the result of imperfect digestion and assimilation, the mate- 
rial thrown out having served no purpose in the body, or 
whether, as some suggest, it is the detritus of the tissues, and 
dependent for its character on an imperfection of nutrition 
and excretion. I am inclined to believe that it has its origin 
from both, there being only this difference: that in the one 
case the material has never been used, in the other, that 
though used, its imperfections were such that it had to be 
speedily removed. 

Symptoms. — In the early sta^e of the disease we notice that 
the person is in feeble health; there may be no marked lesion, 
no special derangement of any function, but a condition very 
accurately described in the popular phrase — "going into a 
decline." Possibly, at this time the patient has a slight 
cough— more rarely a severe one — occurring principally in the 
evening and morning, occasional lancinating pains in the upper 
part of the thorax, and languor and loss of strength, occasion 
some alarm. The patients' strength having failed, so as to 
unfit them for their usual employment, they consult a phy- 
sician, not for disease of the lungs, which they can with 
difficulty believe, but for the debility and minor derangement 



Phthisis Pulmonalis. 145 

of some function they have noticed, the cough and pain being 
considered of minor importance. 

If we closely examine the patient now, we will find the evi- 
dences of failure of vital power in every symptom. The cir- 
culation is feeble, the skin, kidneys and bowels do not perform 
their functions properly, the appetite is variable, but gradu- 
ally failing, they remark that their food does not seem to 
strengthen them as usual, and nutrition is feeble, as evidenced 
by the soft and flabby muscles. The positive signs of phthisis 
are not yet so fully developed as to be evident to the casual 
observer; yet, the persistent cough, recurring night and 
morning, the neuralgic pain in the apex of the thorax, slight 
hemorrhage in some cases, with many times a well marked 
red line at the border of the gums (gingival margin), is suffi- 
cient evidence. If we can carefully examine the lungs, we 
will find slight dullness on percussion over the apex of the 
lung diseased, or if the tubercle is deposited in mass near the 
anterior surface the dullness will be marked. Auscultation 
gives us a roughening of the respiratory murmur, with more 
or less mucous rhoncus if secretion has been established 
from the bronchial mucous membrane. 

As the disease progresses there is further loss of strength, 
and failure of the functions of digestions and assimilation. 

The cough is more harrassing, the pains in the chest more 
marked and persistent, hemorrhage occurs in about two-thirds 
of the cases, and slight difficulty in respiration is noticed. Now 
commences the breaking down of a portion of the deposit; 
the cough is worse; hectic fever appears in the afternoon; 
night sweats at night ; the appetite is poor, and the bowels 
irregular. The expectoration, which varies greatly in different 
cases, sometimes profuse, at others scanty, but previous to this 
consisting of a yellowish or whitish mucus of considerable 
consistence, now becomes cheesj 7 or semi-purulent, with some- 
times small masses of tubercle in the sputa. This paroxysm, 
if we may so call it, lasts from a few days to sometimes three 
or four weeks, when the worst symptoms gradually give way, 
and the patient ceasing to suffer and regaining some strength 
flatters himself that he is getting well. The tubercle is still being 
deposited, and the amelioration but temporary, for in a short 
time the same symptoms return with increased intensity, the 
patient becoming more and more feeble as the disease advances. 

Finally, the system fails to react and the deposit of imper- 
il 



146 The Eclectic Practice of Medicine. 

fectly organized tubercle is very rapid, and its breaking down, 
and destruction of the tissues of the lung correspond, and in a 
short time the patient's strength is exhausted. 

Diagnosis. — I can not do better than to give the practical 
and clear analysis of the symptoms of this affection by Dr. 
"Walshe. "A young adult who has an obstinate cough, which 
commenced without coryza, and without any obvious cause, a 
cough at first dry, and subsequently attended for a time with 
watery or mucilaginous-looking expectoration, and who has 
wandering pains about the chest, and loses flesh, even slightly, 
is, in all probability, phthisical. If there be hemoptysis, to 
the amount of a drachm even, the diagnosis becomes, if the 
patient be a male, and positively free from aneurism or mitral 
disease, almost positive. If in addition, there be slight dull- 
ness under percussion at one apex, with jerking, or divided 
and harsh respiration, while the resonance of the sternal notch, 
is natural, the diagnosis of the first stage of phthisis becomes 
next to absolutely certain. But not absolutely certain; for I 
have known every one of the above conditions exist (except 
hemoptysis, the deficiency of which was purely accidental) when 
one apex was infiltrated with encephaloid cancer, and no can- 
cer had been discovered elsewhere to suggest to the physician 
its presence in the lung. If there be cough such as described, 
and permanent weakness and hoarseness of the voice, the 
chances are very strong (provided he be non-syphilitic) that 
the patient is phthisical. If decidedly harsh respiration exists 
at the left apex, or at the right apex behind ; if the rythm of 
the act be what I have called cogged-wheel, and there be dull- 
ness, so slight, even, as to require the dynamic test for its dis- 
covery, there can be little doubt of the existence of phthisis. 
If, with the same combination of circumstances, deep inspira- 
tion evokes a few clicks of dry crackling rhoncus, the diagno- 
sis of phthisis, as far as I have observed, is absolutely certain. 
If these clicks, on subsequent examination, grow more liquid, 
the transition from the first to the second stage may be posi- 
tively announced. If there be slight flattening under one 
clavicle, with deficiency of expansive movement, harsh respi- 
ration, and slight dullness under percussion, without the local 
or general symptoms of phthisis, the first stage of tuberculiza- 
tion can not be diagnosed with any surety, unless there be 
incipient signs at the left apex also ; the conditions in ques- 
tion, limited to one side, might depend on chronic pneumonia 



Phthisis Pulmonalis. 147 

or on thick induration matter in the pleura. The existence 
of limited though marked dullness under one clavicle, with 
bronchial respiration and pectoriloquy, so powerful as to be 
painful to the ear, the other apex giving natural results, will 
not justify the diagnosis of phthisis. I have known this com- 
bination when the apex of the lung was of model health, and 
a fibrous mass, the size of a walnut, lay between the two lami- 
nae of the pleura. I would even go further, and say, that the 
combination in question is rather hostile than otherwise to the 
admission of phthisis, as, had tuberculous excavation formed 
at one side, the other lung would, in finite probability, have 
been affected in an earlier stage. Pneumonia limited to the 
supra and infra-clavicular region on one side, and not extend- 
ing backward, is commonly but not always tubercular. Sub- 
crepitant rhoncus, limited to one base posteriorly, is not, as 
has been said, peculiar to tubercle ; it may exist in emphy- 
sema, and in mitral disease. Chronic peritonitis, in a person 
aged more than fifteen years, provided cancer can be excluded, 
involves as a necessity tubercles in the lungs. To this law of 
Louis, it is necessary to add the qualification : provided Bright's 
disease be also absent. Pleurisy with effusion, which runs a 
chronic course in spite of ordinary treatment, is in the majority 
of cases tuberculous or cancerous ; the character of the symp- 
toms previous to the pleurisy, will generally decide between 
the two. Double pleurisy, with effusion, is not, as has been 
said, significant of tubercle ; for it may depend on Bright's 
disease. If the latter disease can be excluded, carcinoma and 
pyohsemia remain as other possible causes. If a young adult 
free from secondary syphilis and spermatorrhoea, and not dis- 
solute in his habits, speedily lose flesh without clear cause, he 
is, in all probability phthisical, even though no subjective chest 
symptoms exist. But he is not by any means certainly so, 
for he may have latent cancer in some important organ, or 
he may have chronic pneumonia. Nay, he may steadily lose 
weight, have dry cough, occasional diarrhoea, and night sweats, 
and present dullness under percussion, and bronchial respira- 
tion under both clavicles, and yet be non-phthisical. I have 
known all this occur in cases, both when the lungs were infil- 
trated superiorly with primary encephaloid cancer, and when 
they contained secondary uodules of the same kind. Failure 
of weight becomes less valuable as a sign of phthisis, the 
longer the thirtieth year has been passed. The discovery of 



148 The Eclectic Pbactice of Medicine. 

cardiac disease with marked symptoms, deposes against, but 
does not exclude the existence of active tuberculization. The 
existence of cancer in any organ is unfavorable to the presence 
of tuberculous disease, but tubercles and cancer may coexist in 
the same lungs." 

Prognosis. — In the early stage of phthisis, if not hereditary, 
but the result of active causes, the prognosis should be favor- 
able ; but when hereditary, or advanced to the stage of break- 
ing down, it is unfavorable. 

Post-Mortem Examination. — On opening the thorax, the 
lungs do not generally collapse as they do when not diseased; 
they are increased in weight, and the diseased parts sink in 
water. On making an incision through the part affected, we 
find tuberculous masses, from the size of a hemp seed to that 
of a pigeon's egg, the larger ones being accumulations of the 
smaller. These differ in condition: some are solid, others 
softened to a greater or less extent, and others broken down, 
forming a pultaceous mass. "We will also observe vomicce, 
more or less numerous, left by the discharge of the tubercu- 
lous material. In some cases they are partially cicatrized; in 
others, free of tubercle, but ragged; and in others, again, con- 
taining a disgusting mass of broken-down tubercle and struc- 
ture of the lung. In some cases we find no trace of organi- 
zation left in the part diseased, the entire tuberculous mass, 
with the lung, seeming to have given way at once, and an 
offensive semi-purulent material is all that is left. 

Tubercle consists of albumen, with some gelatine and fatty 
matter. The division into gray and yellow is but indicative 
of their degree of resistance to change, as all tubercle becomes 
yellow and opaque before disintegration. If examined with 
the microscope, they are found to consist of minute and irreg- 
ular granules, with but slight trace of cells and fibres, show- 
ing their low organization. 

Treatment. — As before remarked, if we expect to cure con- 
sumption, we must do it in the first stage of the disease — I 
say if we cure — when, properly speaking, it should be if 
nature cures, the physician simply removing obstacles. The 
objects to be accomplished are plain: we must increase the 
patient's vitality above the point of tuberculosis, and to do 
this, must get a normal action of all important organs, and 
consequently a healthy pabulum for nutrition. Usually the 
treatment is quite simple — a judicious bitter tonic with Iron, 



Phthisis Pulmonalis. 149 

some of the means named hereafter to arrest the irrita- 
tion of the lungs and cough, attention to the secretions, 
especially to the use of baths, stimulant or otherwise, to 
get a normal action from the skin, a highly nutritious diet, a 
cheerful mind, and exercise in the open air, the more the bet- 
ter, so it is not carried to exhaustion. I have started a patient 
to the Upper Mississippi with a small bottle of the Compound 
Tincture of Oil of Stillingia for the relief of cough, and seen 
him come back in perfect health; and have in other cases no 
worse, used everything that has been recommended and failed, 
becase the patient had not energy enough to get well. Place 
the patient in the best possible condition for regaining his 
general health, and if normal digestion, assimilation and 
secretion is the result, he will get well; if not he will die. 

For the cough a great variety of means are used, some with 
well-defined indications, others empirically. The object is to 
quiet irritation, sometimes of the bronchial mucous mem- 
brane, at others of the pneumo-gastric nerve or its origin, 
the cough is dry and harsh it is usually supposed that nause- 
ant expectorants, as the Lobelia, Sanguinaria, Ipecac, etc., are 
indicated; and though this is often the case, it is not always 
the best plan 01 treatment. If administered they should be 
given in their least objectionable form, and at frequent inter- 
vals, uutil the desired object is attained. A much easier plan, 
if obtainable, is to give the patient a warm bath, at about 100 
degrees, and, at the same time, allow him to inhale the vapor 
of warm water; thorough rubbing with a flesh brush or towel 
should follow, and perfect rest for some hours enjoined. One 
day with such treatment will accomplish more than a month 
with nauseant expectorants. 

Sometimes it seems that the cough is rendered worse by too 
free secretion, which has thus to be removed. In this case 
stimulant expectorants, as the gum-resins, Senega, Squills, etc., 
are administered, with the expectation of lessening the cough 
as the secretion is diminished. It would not be profitable to 
repeat the many formuhe that have been employed, as the 
remedies are all in common use, and every Dispensatory or 
Materia Medica will give their combinations. 

If the remedy for the cough can be so arranged as to answer 
the purpose of a tonic and stimulant it should be done, as #, 
Essl. Tinct, Collinsonia, Essl. Tinct. Achillea, Essl. Tinct. Yer- 
bascum, aa, 3ss; Simple Syrup, 3jss; or, as an alterative and 



150 The Eclectic Practice of Medicine. 

tonic, £, Essl. Tinct, Euonymus, Essl. Tinct. Trillium, Syrup 
of Lobelia, aa, 3j ; the dose of each being a teaspoonful every 
three or four hours. 

Remedies in small doses, to act principally upon the mucous 
membrane of the fauces and pharynx, answer a good purpose 
in many cases where the stomach will not tolerate cough med- 
icines without so deranging it as to destroy the appetite. 
Amongst the most valuable of this class is the Compound 
Tincture of Oil of Stillingia, in drop doses on sugar, slowly 
sw T allowed; or, a preparation of #, Morphia Sulph., grs. i j ; 
Gum Arabic, 3j ; triturate thoroughly, and divide into twenty 
powders; one to be taken without water as often as necessary; 
any narcotic may be used in the same manner. 

All of the narcotics, Opium and its preparations, Conium, 
Belladonna, Hyoscyamus, Hydrocyanic Acid, etc., are em- 
ployed in the latter stages of the disease to check cough. I 
have also used with advantage the Extract of Cannabis Indica 
and Pyroxilic Spirit, as follows, #, Spiritus Pyroxilicus, 3ij ; 
Ext. Cannabis, 3j ; Mel, sij ; Aqua, gyj ; M.; the dose being a 
teaspoonful every two or three hours. 

Inhalations may be employed as named under the head of 
chronic bronchitis and laryngitis, and are often more service- 
able than medicines taken by mouth. 

Hectic fever and night sweats may be controlled by the 
administration of Tincture of Euonymus and Quinia, in the 
early stage of these symptoms. At a later period, we employ 
for the night sweats, Gallic Acid in Essence of Cinnamon, 
Tannic Acid and Nutmeg, or the Aromatic Sulphuric Acid, 
in doses of from twenty to thirty drops, or equal parts 
of Nitric and Muriatic Acids in doses of ten drops, largely 
diluted with Water. The diaphoretic plan has answered a 
good purpose in some cases, as an infusion of Orobanche 
or Beech Drops, or the inner bark of the Platanus or Syca- 
more. The most efficient agent I have ever employed is 
the Oxide of Zinc, in doses of one grain, three or four times 
a day. 

The diarrhoea may be controlled at first by the usual rem- 
edies employed for that purpose. My favorites are the Sub 
Nitrate of Bismuth in doses of five grains in Peppermint 
water and the Epilobium in infusion. I have used the Aro- 
matic Tincture of Guiacum with Tannic Acid with advantage, 
but prefer the means first named. 



Hemoptysis. 151 

• HEMOPTYSIS. 

Hemorrhage from the lungs is a very rare disease, except as 
the result of tubercular deposit ; and though frequently made 
light of, I know of no symptom so certain. It is not, as 
popularly supposed, caused by the rupture of a blood vessel, 
or as some in the profession think, by their erosion during the 
breaking down of tubercle, for blood-vessels are not easily 
ruptured, and they yield to the ulcerative process so slowly 
that obliteration of their cavity takes place some time previ- 
ously. Hemorrhage is, in a large majority of cases, an exu- 
dation from the blood vessels, and its probable cause is, 
compression of the veins by the tuberculous deposit, thus pre- 
venting the free return of blood to the heart. We have a 
similar instance in hemoptysis from disease of the heart, the 
free passage of blood from the lungs through the left auricle 
and ventricle being obstructed 

Symptoms. — Evidences of debility and frequently of disease 
of the lungs precede hemoptysis. There may be no seeming 
cause for i% in some cases, coming on when the patient is sit- 
ting or lying still, or sometimes when asleep ; bnt usually it 
is after exertion, or a fit of coughing. Varying in quantity, 
we find it sometimes raised by an act of coughing, at others 
it seems to flow to the upper part of the larynx, and into the 
pharynx, and is simply spit out. The blood is florid and 
somewhat frothy, differing materially from that in hemorrhage 
from the posterior nares and stomach. A small quantity of 
blood mixed with the secretions from the mouth and throat 
makes a very large show, especially when spit on cloths, or 
into a vessel of water, so that frequently there is not the 
cause for alarm that there might seem at first sight. 

Sometimes the hemorrhage is preceded with chilly sensa- 
tions, and a feeling of faintness, with occasionally a sense of 
oppression in the chest, and some dyspnoea. With its com- 
mencement the patient usually becomes much alarmed, which 
is increased by the excitement of those about, and this is 
usually the cause of the excessive prostration noticed. In but 
few cases is the hemorrhage in such quantity as to destroy the 
patient. Dr. Heberden states that in sixty years' practice he 
had never lost a patient of it, and others testify to the same. 
The quantity of blood lost varies from a few drops to as much 
as ten pounds, the average quantity, possibly, being from one 
to ten ounces. When very free, it occasions much dyspnoea, 



152 The Eclectic Practice of Medicine. 

and requires continuous efforts to free the upper air passages 
from it. 

Diagnosis. — Hemorrhage from the lungs is diagnosed by 
the bright florid character of the blood, its being frothy, 
and raised by an act of coughing or expuition. In some cases 
it is swallowed, or simply runs down the sesophagus, and 
coagulating in the stomach is removed by vomiting ; here we 
have to be guided by the symptoms, the oppression of the 
chest, cough, dyspnoea and earlier appearance of the blood 
will determine its source. Bleeding from the posterior nares 
is more frequently mistaken for hemoptysis, but here the 
darker color of the blood, absence of air in it, the feeling of 
warmth posterior to the palate, and to its being removed by 
hawking, is sufficient for the diagnosis. 

Prognosis. — The prognosis is favorable as far as the hem- 
orrhage is concerned, but unfavorable as regards permanent 
recovery. The greater the hemorrhage the more speedy the 
danger, usually, as we frequently see phthisis manifest itself 
with great rapidity after an attack of this kind. The prog- 
nosis is unfavorable when the hemorrhage is the result of 
heart disease, and it is only in those rare cases where it results 
from temporary congestion of the lungs, that we can assure 
the patient there will be no danger. 

Treatment. — The patient should be immediately placed in 
the recumbent position, with the head elevated, and all phy- 
sical and mental excitement avoided. But few persons should 
be in the room, which should be well ventilated and cool. If 
the feet are cold, a hot Mustard foot bath is very useful, and 
the warmth subsequently continued with a jug of hot water. 

If no other remedy is at hand, a half teaspoonful of common 
Salt may k be given every half hour, and if palatable a small por- 
tion of grated Nutmeg added to each dose. 

If the practitioner called hastily, has Veratrum with him, it 
and the Salt will be found very efficient, it may be adminis- 
tered in doses of from one to three drops every half hour, until 
its effects are perceptible. Gallic Acid, in from two to five- 
grain doses, is one of the best remedies in this case, and may 
be given as often as it seems necessary. The Lycopus Vir- 
ginicus has proven very successful, and may be depended on ; 
it is administered in infusion, 3j, to 3vj, of boiling water; half 
an ounce of the infusion every half hour. Ipecacuanha has 
been highly recommended, and I am satisfied it exerts a marked 



Hemoptysis. 153 

influence ; it may be given in doses of from three to live grains 
every fifteen or thirty minutes, until nausea is induced. 

Sulphate of Magnesia in half drachm doses, with diluted 
Sulphuric Acid, has been used with advantage, as has also 
Alum, in doses of from two to five grains with Gum Traga- 
canth, every half hour. If hemorrhage is feared, Oil of Tur- 
pentine may be used in doses of from twenty to sixty minims, 
every three or four hours. The Oil of Erigeron in doses often 
or fifteen drops, is relied on by many, and I have no doubt 
will answer the purpose in many cases. The Tincture of Vera- 
trum has been named as an excellent remedy in this case, and 
I have employed it in place of the older agent Digitalis. There 
are practitioners that give no other remedy, the treatment 
being, warmth to the feet, the recumbent position, perfect 
quiet, and Digitalis in doses of one or two grains every hour 
or tw r o, until the desired effect is induced. If the hemorrhage 
is profuse, and the remedies named do not act speedily enough, 
apply ligatures to the lower extremities, and continue them 
almost to syncope ; this will arrest the flow of blood and give 
time for other medicines. 

The patient should be kept quiet for some time after the 
hemorrhage has ceased, and treatment adopted to counteract 
the ill effects of the loss of blood. The judicious administra- 
tion of tonics, stimulants, and Iron are advantageous, as is also 
fresh air, exercise, change of scene, a nutritious diet, etc. As 
the patient is in constant dread of another attack, he should 
be furnished with the necessary remedies to check it, which 
gives him confidence. Instead, however, of using the stronger 
medicines named, continually, it is better to put the patient on 
the use of an infusion of Lycopus, or Tincture of Achillea, or 
Trillium. The Myricin, in connection with Hydrastine, in 
doses of one grain three times a day, is sometimes useful. One 
of the principal objects in the treatment is to prevent undue 
determination of blood to the lungs, by keeping free circula- 
tion to the skin and extremities ; if this is attended to, there 
is but little danger of hemorrhage. 



PLEURITIS. 

The serous membrane enveloping the lungs, is not unfre- 
quently the seat of inflammation, which' when occurring with- 
out disease of the lungs, is called pleurisy. A milder form 



154 The Eclectic Practice of Medicine. 

occurs with pneumonia, and is termed pleuro-pneumonia, this 
has already been spoken of. 

It will be recollected that there are two distinct pleural mem- 
branes, one for each side of the thorax, and that each of these 
consists of two parts, one investing the thoracic wall, pleura- 
costalis, the other enveloping the lung, pleura-pulmonalis. 
Hence we usually find the disease confined to one side, and 
not unfrequently to either the pleura-costalis or pulmonalis. 
Like all other inflammations, effusion occurs after a variable 
length of time, but as the structure is so delicate it is thrown 
off from the free surface, instead of being deposited in its 
tissue. 

The inflammation having subsided, the effusion is absorbed, 
or in some cases becomes organized as a false membrane or 
adhesions. 

Symptoms. — Sometimes pleurisy is preceded for a short time 
by languor, headache, loss of appetite and derangement of the 
secretions, but usually there are no evidences of disease until 
the commencement of the chill or pain. A marked chill usu- 
ally ushers in the disease, sometimes it is preceded by pain, at 
others, it is not ; fever follows and is generally high. The 
pain is sharp and lancinating, increased when the thorax is 
moved, much easier when kept perfectly quiet. In conse- 
quence of this pain, we find the respiration short and hurried, 
and principally abdominal, as anything like a full inspiration 
produces excruciating suffering, A dry hacking cough attends 
the disease, and is a source of great annoyance to the patient. 
Pleurisy is characterized by a hard, small, frequent pulse, run- 
ning sometimes to from 120 to 140 beats per minute ; the skin 
is dry and harsh, the urine scanty, tongue coated white, and 
bowels constipated. 

These symptoms continue without change for from one to 
three days, unless arrested by treatment, when effusion tak- 
ing place the pain is lessened, but the difficulty of breath- 
ing and other symptoms are increased. The fever now is 
markedly lessened, the pulse is still frequent, but has lost its 
hardness, the trunk is hot, but there is tendency to coolness of 
the extremities, the secretions are yet checked, there is still 
cough, and sometimes expectoration, the patient feeling very 
much prostrated, especially after a paroxysm of coughing. 
The difficulty of breathing is sometimes so great that the 






Pleueitis. 155 

patient can not lie down ; in such cases there is abundant 
effusion. 

The disease may terminate fatally in the first or second 
stage. If in the first, the fever is very high, and the 
pain excruciating; the pulse is wiry and quick; respiration 
rapid, sometimes fifty per minute; delirium ensues, and the 
patient succumbs, usually within forty-eight hours. After 
effusion we find the patient losing strength, day by day, a low 
form of remittent fever is present, respiration is difficult, the 
patient has no appetite, and is generally worn out. 

The physical signs noticed are a sound of friction heard 
daring the first stage; it is not constant, and has not been 
explained. Dullness on percussion over the most dependent 
portion of the affected side is present when effusion has taken 
place. If the effusion is of coagulable lymph, the dullness 
may extend over the entire seat of the inflammation. Dimin- 
ished respiratory sound, with less motion of the thorax, is ob- 
served, and is in proportion to the amount of the effusion. If 
the ear is applied over the effusion, while the patient is speak- 
ing, the sound will seem tremulous, and is termed segophony. 
If the effusion is serous, and to considerable extent, it will be 
noticed that the intercostal spaces are distended to a level, and 
in some rare cases, distinct succussion can be obtained by pal- 
pation. 

Diagnosis. — The sharp, lancinating pain, with difficult re- 
spiration and cough and febrile action, is sufficient to deter- 
mine the nature of the disease. The moderation of the pain, 
oppression of breathing, dullness on percussion, diminished 
respiratory movement, and segophony, determines that effu- 
sion has taken place. 

Prognosis. — In the early part of the disease we can safely 
promise a favorable result in most cases ; but where effusion 
has taken place, though the danger to life may not be in- 
creased, yet recovery will be retarded, and in some cases diffi- 
cult. 

Post-Mortem Examination. — In the early stage of the dis- 
ease we observe a congested state of the capillaries, and larger 
or smaller red patches, which sometimes become dark, and 
look like ecchymoses ; still further, the pleura loses its smooth- 
ness, and becomes dull and opaque, the redness is more uni- 
form, and small points or patches of a yellowish color make 
their appearance. Consequent upon these changes, we next 



156 The Eclectic Practice of Medicine. 

notice the effusion, which, sometimes serous with some floc- 
culi, is at others composed in considerable part of coagulable 
lymph, more or less organized and attached to the inflamed 
surface. If the disease has progressed for some time, we 
notice this lymph assuming various forms, sometimes as 
long, bridle-like adhesions, at others, close, like short areolar 
tissue, and again forming a false membrane, the surface being 
still free, or uniting them together so closely that it is diffi- 
cult to separate them with the scalpel. 

Treatment. — The objects of treatment are to lessen the 
rapidity and equalize the circulation, and by different means 
of derivation check the flow of blood to Die pleura. We can 
accomplish this in different ways : thus, one will have an infu- 
sion of the Compound Powder of Lobelia made, and give it 
freely until nausea is induced, and after this has relaxed the 
system and mitigated the pain, give it to produce thorough 
emesis. It would seem at first sight as if the patient could 
not bear the severe movement of the chest necessary in vom- 
iting, when the hacking cough produces so much disturbance, 
but we find the nausea to so check the pain that the vom- 
iting does not occasion additional suffering. Others again 
would arrive at the same result hj inducing profuse dia- 
phoresis with the spirit vapor bath, and the free adminis- 
tration of an active diaphoretic, as the Compound Tincture of 
Virginia Snake-root. 

It will be noticed that these means are powerfully relaxant, 
indirectly sedative, and thoroughly revulsive, and will some- 
times check the disease at once. I have seen it treated by 
Podophyllin, in doses of from half to one grain every three 
hours until emeto-catharsis was induced, and am satisfied, in 
my own person, that it is very effective, though extremely 
unpleasant. 

A much more pleasant treatment is to give the patient Tinc- 
ture of Veratrum in doses of from three to fixe drops every 
hour until partial sedation is induced, and then add the Tinc- 
ture of Asclepias in half drachm doses. It is well to get an 
action on the bowels with the Podophyllin pill heretofore 
named, and in some cases add sufficient Opium to mitigate the 
distress. Cups to the affected part, followed by hot fomenta- 
tions, or a warm poultice of Wheat-bran, assists very mate- 
rially. A sinapism, followed by hot Hop or Stramonium 



Chronic Pleuritis. 157 

fomentations, may be used instead. Or the cold water band- 
age recommended by some may occasionally be found useful. 

After the effusion has taken place, I put the patient upon 
the use of Quinia and other bitter tonics, keep the bowels 
open, and use Asclepias as a diaphoretic. An alkaline diuretic 
is important in this case, as the Acetate or Citrate of Potassa, 
or sometimes the Iodide of Potassium for the purpose of pre- 
venting the organization of false membrane and promoting 
secretion. To the surface I apply the irritating plaster, leav- 
ing it on without changing until the patient complains of 
soreness. 



CHRONIC PLEURITIS. 

Under this head may be included those cases in which the 
acute symptoms having stopped, the disease continues without 
any very aggravated features, and those in which it commences 
slowly and insidiously, without any severe pain or constitu- 
tional disturbance, and in which measures are not adopted for 
its removal. These last cases are by far the worst, as there is 
danger of mistaking the affection, or considering it some un- 
important matter, and thus neglecting proper treatment until 
extensive change of structure has taken place. 

Symptoms. — Chronic pleurisy manifests itself by occasional 
sharp, lancinating pains through the affected part, especially 
after exertion, much talking, coughing, etc. We call the pain 
sharp and lancinating, but it may be more properly described 
as an intense, sharp soreness, which catches the part during 
inspiration, aud stops the movement at once ; the patient calls 
it a " stitch in the side." In addition, there is frequently sore- 
ness on pressure, or when the arm of that side is moved. Re- 
spiration is more frequent than usual and somewhat difficult, 
there is more or less of a hacking cough, sometimes dry, but 
very frequently attended with expectoration, sometimes co 
pious. 

The general health is markedly affected, there is loss of 
flesh and strength, the appetite is poor, bowels irregular, skin 
harsh and dry, pulse 96 to 100, and much irritability of the 
nervous system. Usually there is hectic fever in the evening 
and night sweats, sometimes as marked as in phthisis. In 
some cases, the inflammation terminates in suppuration ; not 
only does the effused lymph break down into pus, but the 



158 The Eclectic Practice of Medicine. 

serous membrane becomes a pus secreting structure from its free 
surface. In such cases there is marked cachexia and finally 
secondary abscess, which terminates the life of the patient. 

Diagnosis. — Chronic pleurisy is in some cases an obscure 
disease, and with difficulty diagnosed. The pain in the chest, 
and cough, point to the lungs as the seat of the disease ; the 
location of the pain and its character serve to distinguish it 
from phthisis, which in a very large majority of cases affects 
the apex of the lungs. The dullness on percussion in differ- 
ent portions, and the change in the respiratory sounds evi- 
dence the amount of change. 

Prognosis. — The prognosis will depend upon the extent of 
the disease, and the condition of the general health ; as a gen- 
eral rule, it should not be considered unfavorable. 

Post -Mortem Examination. — The scalpel usually reveals suf- 
ficient lesions to account for death. We find the pleural 
membrane thickened, its surface dull and rough, more or 
less false membrane and adhesions, and a variable amount of 
fluid, sometimes serous, at others purulent. Occasionally the 
lung covered by the diseased pleura has suffered to a con- 
siderable extent; effusion has occurred in it, which breaking 
down may have been the cause of death. Occasionally the 
effusion has been so great as to prevent any expansion of the 
lung, and we find it occupying a very small space near the 
mediastinum. 

Treatment. — This, like other chronic inflammations, yields 
slowly to measures that promote absorption, remove irritation, 
and restore the tone of the system. Counter-irritation is 
among the most prominent of our medicinal measures, and must 
be continuously employed. I use the irritating plaster, apply- 
ing it over quite a large surface, re-spreading it every two 
days until it commences to feel unpleasant, then removing 
and reapplying when the irritation has gone down. A very 
good plan is apply it to one-half the surface you desire to 
affect, and when it has to be removed, apply it to the other 
half. 

The means already named for the arrest of cough in speak- 
ing of other diseases of this class, ma} 7 be employed here. In 
addition, a judicious alterative and tonic course of treatment 
should be adopted, as #, Compound Tincture of Corydalis, 
giij ; Essl. Tincture of Cornus, 3j ; Essl. Tincture of Hydrastis, 
3ss ; M., and give one or two teaspoonsful every four hours; or 



Chronic Pleuritis. 159 

#, Podophyllin, gr. v; Ext. Hyoscamus, gr. xx; Iodide of 
Potassa, 3ss ; Extract Nux Vomica, gr. iij ; Hydrastine, gr. v ; 
M. and make twenty pills, one to be taken four times a day. 

The surface should be bathed in salt water once a day, and 
brisk friction employed, or if relaxed, a stimulant bath may 
be substituted for it. Sometimes we find great benefit, in 
cases where the skin is dry and harsh, from the warm bath, 
followed when the patient can bear it with the cold douche. 
In others, the patient being naturally robust, I should favor 
the use of the wet sheet pack, if it seems difficult to get a nor- 
mal action of the skin. The same means may be employed 
for hectic fever and night sweats that were recommended un- 
der the head of consumption. 

There are cases in which a more active treatment may be 
employed with advantage. Thus, if the disease is stubborn, 
and the strength is yet good, an emetic administered three or 
four times a week, will exert a marked influence on the disease, 
especially in cases where there is inconsiderable irritation of the 
lungs. This may be followed by Iodide of Potassium in full 
doses with some vegetable diuretic, and sufficient stimulants to 
prevent any prostrating effect. Cups thoroughly applied may 
be substituted for the irritating plaster, or both may be used. 

When dropsy is the result, we must treat it in the manner 
hereafter named when considering that disease. Occasion- 
ally it is found necessary to remove the fluid by tapping, as is 
also the case in pysemia. Should this be necessary in either 
instance, the best plan probably is to make the incision through 
the eighth or ninth intercostal space, just anterior to the 
angles of the ribs, and especially in accumulations of pus, 
remove the fluid with the syringe fitted to the trocar. In severe 
cases of this kind, it is recommended, after withdrawing the 
pus, to inject Tincture of Iodine, 3ij ; Tepid Water, 3iij ; and 
increase the strength each time, until in some cases it may be 
used pure. Others recommend the drainage pipe of Ch as- 
sign ac, which has been employed in some cases with marked 
success. 



PERTUSSIS. 
(whooping cough.) 
We may properly consider this affection here, as, though 
primarily not one of the respiratory apparatus, it becomes dan- 



160 The Eclectic Practice of Medicine. 

gerous to life by the change it induces in these organs. It 
is eminently a contagious affection, though how it is propa- 
gated is more than is known. Usually it is contracted only 
when children are brought in such immediate proximity that 
the breath or exhalations of the diseased person is inhaled; 
this, however, is not always the case, as the poison seems to 
contaminate the atmosphere so that persons take it when at 
considerable distance from those having it. 

It is undoubtedly a disease of the nervous system, the parts 
implicated being the pneumo-gastric nerve and medulla oblon- 
gata at its origin. And yet, post-mortem examination has not 
shown any more serious lesion of the medulla than evidence 
of determination of blood, which we would be likely to rind in 
any case of such prolonged irritation of the parts to which the 
nerve is distributed. Like other contagious diseases, it runs a 
very regular course, and gives immunity against a subsequent 
attack. 

Symptoms. — Whooping cough manifests itself at first as a 
simple catarrh, the cough being gradually developed. Some 
days elapse before there is anything distinctive in it; and it is 
not usually well marked under from two to four weeks. The 
cough differs from others in that it seems to arise from an 
obstruction to respiration, and forcible inspiration is taken, 
and then there is a series of short expulsions until the air is all 
expelled; the tendency to cough still continuing produces 
great distress, and more or less evidences of impaired respira- 
tion are noticed. The whoop is developed when the cough 
becomes intense, and is the shrill sound formed as the air is 
drawn through the yet contracted larynx in the forcible inspi- 
ration succeeding the cough. The cough is paroxysmal, the 
paroxysms recurring at longer and shorter intervals in propor- 
tion to the severity of the disease. 

There is a secretion of glairy mucus in most cases, which is 
raised at the latter part of the cough, and frequently seems to 
increase the suffering. If the disease is very severe, and 
sometimes when mild, there is a free yellowish expectoration. 
There is necessarily some fever at the commencement of the 
disease, and it may occur during its progress. 

Writers divide pertussis into three stages : the first, lasting 
from five to fifteen days, presents the symptoms of ordinary 
catarrh ; the second, lasting from three to six weeks, presents 



Pertussis. 161 

the peculiar who op, which gives name to the cough; and the 
third, of variable duration, is the period of decline. 

It is during the second stage of the disease that the symp- 
toms become so aggravated as to demand relief. We some- 
times see the paroxysms of cough so severe that the little 
patient will turn purple in the face, gasp for breath, and even 
for some time afterward exhibit marked evidences of imper- 
fect respiration. Occasionally bronchitis sets in and is very 
troublesome ; sometimes there is marked congestion of the 
lungs ; at others, the frequent and severe paroxysms of cough- 
ing prevent necessary rest, derange the functions of the body, 
and wear the patient out. In some cases there is tendency in 
the disease to recur, for months after it has ceased, on expo- 
sure to cold, though almost always in a mild form. Instead 
of impairing the strength of the lungs in feeble children, it 
seems rather to have increased it, and may sometimes be re- 
garded as of marked advantage to the child. 

Diagnosis. — In the first stage it is with difficulty recognized, 
but in the second the paroxysmal character of the cough, its 
long continuance without seeming cause, and the peculiar 
whoop is sufficient for the diagnosis. 

Treatment. — Many plans of treatment have been recom- 
mended for whooping-cough, but most of the remedies used 
are employed empirically. An emetic administered occasion- 
ally sometimes affords marked relief, and in some cases it may 
be repeated daily. The nauseant expectorants are employed 
by some, but without advantage ; in fact, though they may 
mitigate the cough at first, they add to the danger by derang- 
ing the stomach. 

A favorite prescription of mine in this disease is #, 
Extract Belladonna, gr. v; Alum, 3 j ; Syrup of Senega, Sim- 
ple Syrup, aa, 3ij; M.; to a child two years old, a teaspoonful 
may be given every two or three hours; if older, the amount 
of Belladonna may be increased. The Nitric Acid mixture 
of Dr. Gibbs answers a good purpose : it is composed of Nitric 
Acid, dilute, 3xij; Compound Tincture of Cardamoms, 3iij; 
Simple Syrup, Siijss; Water, 3j; M., and give a teaspoonful 
every two hours. Extract Conii, gr. xij; Alumiuus, 3ss; 
^Ether Sul., 3ij; Syrupus Simplex, 3iv; M. ; in doses of a tea- 
spoonful every two or three hours will sometimes give speedy 
relief. The formula of Dr. Beatty, used with much success : 
#, Compound Tincture of Bark, 3v; Tincture of Lytta, 
11 



621 The Eclectic Practice of Medicine. 

Tincture of Camphor, aa, 3ss; M.; may be given in doses of 
a teaspoonful three or four times a day. The Cochineal mix- 
ture — #, Cochineal, gr. x; Bitartrate of Potash, bj; Sugar, 
3j; Water, gvj; M., and give a teaspoonful every three or 
four hours — is an old and popular remedy. 

An infusion of common Clover Hay has been latterly 
recommended very strongly, as follows: #, Trifolii in fceno, 
Sijss; Sacch. Cand., 3ij ; Aqua Ballient, Oj; macerate the Hay 
in water for an hour with gentle heat, then boil down to a 
proper consistence; two teaspoonsful may be taken every 
three or four hours. Other remedies have been used, but with 
out such success as would warrant their trial in severe cases. 
As regards the general treatment, it should be such as will 
keep the secretions free, and meet indications as they arise. 



Diseases of the Heart. 163 



CHAPTER III. 

DISEASES OF THE CIRCULATORY APPARATUS. 

The diseases of this portion of the body have not been as 
thoroughly studied as those of other parts, probably on 
account of the obscurity of the symptoms. They are worthy 
of close attention, however, as, contrary to old authorities, 
they may be diagnosed with much accuracy, and treated with 
success. 



DISEASES OF THE HEART. 

The heart, the center of the circulatory apparatus, and the 
source of motive power for the circulation of the blood, is sub- 
ject to both functional, and structural or organic disease. It is 
only within the last century that much attention has been 
directed to diseases of this viscus; and, although there is 
great difficulty in their investigation, yet our knowledge of 
many of them is pretty thorough. 

With these, as with all other diseases, it is necessary, in 
order to make a correct diagnosis, that the structure and rela- 
tions, as well as the physiological action of the organ, should 
be perfectly understood — we must know its healthy condition 
before we undertake to detect pathological change either in 
function or structure. This knowledge may be obtained, in 
some degree, from books — that is, from anatomical works, we 
learn the minutiae of its structure ; from physiological works, 
its function — but he who depends altogether upon books to 
obtain a knowledge of either anatomy or physiology will be 
but very poorly instructed. In order to become a good anat- 
omist, it is necessary that personal dissections and examina- 
tions be made; so in physiology, where possible, personal 
investigation is highly necessary. To illustrate this, it is only 
necessary to refer to the sounds produced by the heart's action — 
one of the most important means of diagnosing structural dis- 
ease. A physician, depending upon books for his knowledge 
of the natural sounds, would be entirely incompetent to detect 



164 The Eclectic Pbactice of Medicine. 

an unnatural or morbid sound. This practical knowledge of 
the workings of this most complicated mechanism — man — -can 
only be obtained by close and long-continued study. The eye, 
the ear, the touch, as well as the other senses, must be edu- 
cated, so as to determine what is a physiological condition, 
and the slightest variation from this. It is this careful educa- 
tion of the senses, in addition to a thorough medical educa- 
tion, that makes the good physician, and gives him an emi- 
nent position in the profession. 

cf the structure and relations of the heart. 

"We notice the structure of this viscus here, in order that 
we may fully understand the nature of the diseases to which 
it is subject: 

1. The heart is a muscular organ, and hence this tissue is 
subject to the same affections as other muscles — a, to inflam- 
mation ; b, to hypertrophy ; c, to atrophy ; d, to degeneration ; 
e, to rheumatism; and, /, to spasmodic action. 

2. It is invested with a serous membrane, — a, liable to in- 
flammation ; b, adhesive : c, morbid growths ; and, d, effusions 
within its cavity. 

3. Within its cavity we find fibrous tissues, the chordae ten- 
ding, the base of the valves, and the interior structure of the 
valves, liable, principally, — a, to alterations of the structure, 
and, 6, to fibroid growths. 

4. It is lined by a membrane, resembling the serous mem- 
branes in many respects, which is liable, — a, to inflammation ; 
6, to morbid growths and change of structure. 

"We find important nervous connections between it and other 
organs; 1st, with the entire sympathetic system of nerves, 
establishing a sympathetic relation between it and all parts of 
the body supplied by these nerves; we might specially note 
the stomach, digestive canal, chylopoietic viscera, the urino- 
genital organs, and lungs; 2d, with the spinal cord, through 
the fibers of communication between it and the sympathetic 
ganglia ; 3d, with the medulla oblongata through the pneumo- 
gastric nerves, and hence with the brain and all parts to which 
this portion of the spinal cord sends nerves. It is also influ- 
enced by the condition of the blood, not only by that which 
is distributed to its own tissue, but also by the mass that 
passes through the cavities ; and by the physical condition of 
the arteries and veins, especially by any obstruction to the 



Enfeebled Action of the Heart. 165 

passage of blood through, them. From these considerations, 
it is not strange that the viscus should be diseased, but that 
disease of it should be so unfrequent. 

FUNCTIONAL DISEASES OF THE HEAET. 

Functional diseases of the heart may be divided into four 
classes : — 1. Enfeebled action ; 2. Irregular action ; 3. Excited 
action ; and, 4. Neuralgic affections. 



ENFEEBLED ACTION OF THE HEART. 

The action of the heart may be enfeebled by organic disease 
effecting a change in its structure, the feeble action being but 
a symptom. This, however, and the means of diagnosis, will 
be considered hereafter. We wish here only to consider it as 
it occurs without any lesion of this viscus. Two principal 
causes may give rise to this condition : 1st, an anaemic con- 
dition of the system, from whatever cause produced ; and, 2d. 
from want of proper innervation. In the first instance, the 
cause is obvious, the diagnosis eas}', and the indications of 
cure, plain. 

"Where want of proper innervation is supposed to be the 
cause, it becomes necessary to closely examine the patient, and 
ascertain, if possible, the lesion giving rise to this, and whether 
it is consequent upon debility of the cerebo-spinal, or sympa- 
thetic nervous systems. We sometimes observe cases of chronic 
disease, in which we can detect no lesion of digestion, assimi- 
lation, or excretion ; and in which there is no apparent debility 
of the cerebo-spinal nervous system, but in which, although 
all the functions appear to be well performed, yet the patient 
is unable, from debility, to follow his usual avocation. These 
cases are probably rare, but yet occur sufficiently often to 
merit attention. My attention has been directed to the sub- 
ject, from the occurrence of two such cases in my practice ; a 
description of one of which may not prove uninteresting: — 

Mr. Gr. T , set. 35, sanguine lymphatic temperament, 

stout, heavy-built, with every appearance of good health, was 
affected with chronic laryngitis through the spring of 1857. 
In June, he applied to me, and by the use of ordinary measures, 
the disease was nearly subdued in the course of a month. At 
this time, I noticed that the pulse was weak; that there ap- 



166 The Eclectic Practice of Medicine. 

peared to be difficulty in the circulation of the blood, and a 
tendency to congestion in various parts of the body ; although 
at the same time the patient was stout and fleshy, the muscular 
system well developed, and digestion and excretion normal. 
Through the months of August and September, he had fre- 
quent attacks of almost entire muscular prostration, lasting 
from fifteen minutes to one or two hours; the recovery from 
them being gradual. These almost invariably commenced 
with a feeling of fullness of the chest and pressure over the 
heart, the pulse being very feeble. These attacks so increased 
in frequency, and the consequent debility was so great as to 
entirely preclude him from following his trade. A close ex- 
amination of the heart and lungs, showed conclusively to my 
mind, that the viscera of the thorax were in a health}' condi- 
tion. There was no tenderness in any part of the spinal col- 
umn, nor any symptoms of affection of the brain ; the appetite 
was good; bowels regular; and the secretions of the skin and 
kidneys, normal. In fact, after the most careful examinations 
of the case, by myself and others — watching it closely for 
months — I could detect no disease, to account for the symp- 
toms, but the continued impaired action of the heart and 
weakness of the circulation, which undoubtedly arose from 
deficient innervation, the sympathetic nerves and ganglia sup- 
plying the heart being affected. This patient has nearly or 
quite recovered. 

Several mild cases have come under my notice, in which 
other disease was aggravated from this cause. In a majority 
of them, probably, there was deficient innervation in all organs 
supplied from the sympathetic system of nerves. 

Treatment. — Where debility or weakness of the heart's 
action depends upon ansemia, it will, in a majority of cases, be 
removed by the judicious use of tonics and Iron, the indications 
being to restore the normal quantity and quality of the blood. 
When it depends upon loss of nervous energy, the indication 
is to restore this ; and here we find our therapeutic resources 
exceedingly meagre. It will probably be found, in a majority of 
cases, that the urine persistently contains a larger or smaller 
amount of the phosphates; which almost invariably occurs 
with a depressed state of the nervous system. From this fact 
I was led to employ the phosphates in the two cases above 
named, as well as in analogous cases ; and so far, with the best 
results. I might premise, however, by stating, that it is 



Irregular Action of the Heart. 167 

indispensable to success, that if the stomach and bowels be 
disordered, if there is indigestion, or the different nutritive 
processes are impaired, the attention must first be directed to 
these. At the same time, it is highly necessary that we 
have a normal action of the kidneys and skin. Having ac- 
complished this, we may resort to measures to restore the 
deficient nervous force. Prominent among agents to fulfill 
this indication, I may name the different preparations of the 
Phosphates. I prefer the Hypophosphite of Lime, though the 
Phosphate may be used with advantage, or even finely pow- 
dered bone. These agents will have to be continued for a 
considerable length of time before much apparent advantage 
is gained; thus, in giving the Hypophosphite of Lime in five- 
grain doses, three times a day, in my worst case, it was some 
six weeks before I could perceive any improvement ; yet after 
this, there was perceptible improvement each week. With 
the agent just named, I employed the Hydrochlorate of Am- 
monia in the same doses, the patient using a bath of the 
infusion of the bark of Quercus Alba, with brisk friction, twice 
a day. The Extract of Nux Vomica, given in the usual doses, 
gave temporary relief, as did Belladonna. Tonics and Iron 
appeared, if anything, to increase the disease. Moderate and 
continued exercise — as much as the patient could bear, without 
inducing symptoms of exhaustion — was always beneficial ; as 
was also pleasant and agreeable company. 



IRREGULAR ACTION OF THE HEART. 

This, in a mild form, is quite a common affection, in persons 
of an irritable and debilitated habit. " The pulsations may be 
unequal in frequency and power, or they may be intermittent, 
reiterated, or fluttering. This state of action, although at- 
tending various dangerous diseases of the organ, may be 
entirely nervous, or connected with depressed organic nervous 
power, and enfeebled action of the stomach and bowels.*' We 
observe it, sometimes, as a symptom of dyspepsia; especially 
where the disease has continued for a length of time in persons 
of a nervous habit. It is also a symptom in chronic inflam- 
mation of the lungs, where it has been of such extent as to 
prevent the free passage of the blood. It may also proceed 
from mental emotions, and from long-continued and severe 



168 The Eclectic Practice of Medicine. 

mental labor ; especially in cases where the mind is troubled, 
as from want of success in life, etc. Probably the most fre- 
quent cause, when it is severe, is long-continued disease of the 
organs of generation, especially sexual excesses and mastur- 
bation. The disease arising from these latter causes frequent- 
ly assumes a serious form, attended with a sense of weight, of 
sinking, or oppression, or anxiety, at the prsecordia ; dizziness, 
vertigo, singing in the ears, dimness of vision, etc. In severe 
cases, the pulse will rarely be found normal, either in fre- 
quency or regularity ; sometimes soft, fluent, easily compressed, 
but the pulsations extremely irregular; at others, hard, sharp, 
quick, dicrotous, or intermittent. In a majority of these cases, 
there will be found — especially if it has arisen from sexual 
derangement— tenderness on pressure, over the first and second 
cervical vertebra ; and also over the last two; and, frequently, 
the patients will complain of a heavy, dull, aching pain in the 
back part of the head, or, at least, of a sensation of weight 
and soreness. 

Treatment. — It is very important, here, that a correct diag- 
nosis be made, — that we do not treat this symptom of organic 
disease as a nervous affection. Having decided that it is 
nervous, the next point to determine is, what has been the 
cause of it. If it has arisen from irritation, a disordered state 
of the stomach and bowels — and this is generally easily deter- 
mined — the removal of the primary disease will be succeeded 
by the cessation of this symptom. If from any cause retard- 
ing the flow of blood, and consequent overloading of the 
cavities of the heart, we remove the cause if possible, and this 
symptom will in all probability cease. If from severe mental 
labor, such measures should be adopted as will give rest to the 
over-worked organ, and restore the natural tone of the sys- 
tem. If from sexual excitement, this must be controlled ; and 
if from masturbation, the cause must be arrested, or but little 
good can be accomplished. In all cases, it becomes necessary 
to adopt measures to restore the general health, as the exhibi- 
tion of the bitter tonics and Iron, the use of easily-digested 
and nutritious food, exercise in the open air, the daily bath — 
especially of some bitter infusion, as Cinchona, Hydrastis, 
Cornus Florida, etc., with brisk friction. It is also necessary 
that we pay especial attention to the secretions of the kidneys, 
bowels, and skin ; for if expect to restore the tone of the sys- 
tem, we must have a normal action of the excretory organs. 



Excited Action of the Heart. 169 

In all cases, where there is tenderness on pressure over the 
cervical vertebra, or weight, pain, or soreness in the back part 
of the head, counter-irritation over the cervical region will be 
found of the greatest importance. I employ the irritating 
plaster, not as it is generally used, but by applying it for two, 
three, or four days, or until it commences to be painful ; then 
removing for twelve or twenty-four hours ; again applying it, 
continuing it in this way, without producing suppuration. It 
may also be applied over the region of the heart, in the same 
way. As internal remedies, in addition to tonics and Iron, I 
know of none better than the Nux Vomica, Veratrum Yiride, 
and Gelseminum, as in the following formula : #, Tincture 
K"ux Vomica, f3j ; Tincture Veratrum Viride, f3j ; Tincture 
Gelseminum, f3ij ; Syrupus Simplex, f3ijv ; dose, 3ss, three, 
four, or five times a day. 

When there is debility of the nervous system, the Hypo- 
phosphite of Lime may be used. The additional means 
recommended for palpitation of the heart, are also often appro- 
priate. 



EXCITED ACTION OF THE HEART. 

This is denned by Dr. Copland, as " strong, frequent, or 
tumultuous action, with an increase of the impulse and natural 
sounds of the heart, so as to be sensible, and often distressing, 
to the patient, without appreciable lesion of the structure of 
the organ." Palpitation is a frequent symptom of some of 
the serious organic affections of the heart, to be hereafter de- 
scribed ; hence, the diagnosis must be carefully made. 

Causes. — Many causes may give rise to temporary palpita- 
tion of the heart ; but it is only those cases in which palpitation 
is severe, long-continued, recurring frequently, and attended 
by manifest disease of the system, that we wish to consider. 
Three pathological conditions of the system may give rise to 
this disease : 1st, a change of the quantity or quality of the 
blood ; 2d, irritability of the muscular fiber of the heart ; 
and, 3d, irritation of some part of the nervous system ; the 
last condition being much the most frequent cause. 

Symptoms. — Palpitation is frequently sudden in its occur- 
rence, coming on after, or during, over-exertion; sometimes 
the slightest exercise will give rise to it, or after, or during, 



170 The Eclectic Practice of Medicine. 

any mental emotion; sometimes it comes on slowly, increasing 
in intensity gradually. The action of the heart is strong, 
sometimes labored ; the natural sounds frequently increased in 
intensity, sometimes so as to be audible without placing the 
ear to the chest. The impulse of the heart against the parie- 
ties of the thorax is always perceptible when the hand is 
placed upon the chest ; in severe cases, it may be noticed by 
the eye, so that the pulse may be counted without approach- 
ing the bedside. The patient generally complains of a sense 
of weight at the preecordia ; sometimes pain, with difficult 
respiration, or sensation of smothering. Sometimes, when 
the action is excessive, it is irregular, tumultuous, and attend- 
ed by distressing anxiety ; sense of sinking, or anguish, at the 
prsecordia ; and by extreme restlessness, and a feeling of im- 
pending dissolution. The paroxysms may be of short dura- 
tion, from a few minutes to one or two hours ; or, they may 
continue for twelve, twenty-four, or even forty-eight hours. 
They mostly recur at irregular intervals, though sometimes 
they are periodic, occurring at regular periods. 

Diagnosis. — In general it is quite easy to determine whether 
or not, the palpitation depends upon organic disease of 
the heart, if the patient be examined when the paroxysm is 
off*. In organic disease, when palpitation is induced, the 
extended dullness on percussion, the morbid or adventitious 
sounds, the more or less constant dyspnoea, nervous congestion, 
bloated countenance, dropsical effusions, etc., will determine 
the case. 

Treatment. — If produced by alteration in the quantity or 
quality of the blood, our measures should be directed to the 
attainment of a normal condition of this fluid. In nearly all 
cases, we find deficient action of the excretory organs, and 
consequent retention of excrementitious materials. By the 
use of the alkaline bath, or cold bath, if the skin is harsh ; 
or a bath of an infusion of the bitter tonics and astringents, 
if it is relaxed or flabby, we obtain normal excretory action. 
The diuretic salts, in small doses, will increase the excretion 
of the kidneys. The bowels should be kept in a soluble con- 
dition with mild laxatives. Then, the stomach being in a 
normal condition, by the use of bitter tonics and Iron, nutri- 
tious food, and moderate exercise in the open air, we increase 
the quantity and quality of the blood. 

For the temporary relief of the patient during the parox- 



Neuralgia of the Heart. 171 

ysru, Tincture of Gelseminum in 3ss doses; or, what is better, 
the Concentrated Tincture of Lobelia, in the same doses, is 
almost always sufficient. 

In those cases where the disease is undoubtedly owing to 
increased irritability of the muscular fiber of the heart, or 
irritation of the nerves supplying it, we use means to remove 
these conditions. First, if this irritability has been produced 
by sexual excesses, or masturbation, we direct treatment for 
the relief of this excitation of the organs of generation. In 
such cases, and also in many others, we will find tenderness on 
pressure at the base of the brain and over the cervical ver- 
tebra. Here the irritating plaster, continued until the tender- 
ness is entirely removed, is one of our most efficient measures. 
The use of small doses of Gelseminum, Aconite, especially 
Lobelia, "infusion of Scutellaria, and Veratrum, is peculiarly 
serviceable. The irritating plaster, applied over the region of 
the heart, will also, in many cases, afford great relief. Hypo- 
phosphoric Acid, with small quantities of Sulphur, prove very 
efficient, when there is accompanying irregularity of the 
pulse. 

NEURALGIA OF THE HEART. 

This affection is considered as but a modification of angina 
pectoris ; yet it differs from that in many of its symptoms, 
which go to show that the nerves of adjoining viscera are more 
or less affected. The disease is somewhat rare. I have seen 
but one severe case, and one in which the symptoms were 
comparatively mild. 

Symptoms. — The disease frequently comes on slowly, the 
patient, for two or three days or more, complaining of a feel- 
ing of tension and dull aching in the region of the heart, with 
occasional sharp, piercing pains, which last but for a moment. 
When fully developed, there is a most acute, lancinating pain 
passing from under the left nipple, backward, to the spine, 
frequently radiating to the left arm, left side of the neck, and 
adjacent viscera. The paroxysms of pain are almost instan- 
taneous in their accession, lasting from a few minutes to an 
hour or more; when long continued, there are intervals of 
comparative ease, in which there is nothing but a feeling of 
tension and a dull aching. The disease is intermittent, recur- 



172 The Eclectic Practice of Medicine. 

ring sometimes once or twice a day ; at others, not for several 
days. 

During the paroxysms, the action of the heart is frequently 
accelerated; sometimes irregular; rarely slow and labored. 
There is no morbid sound, unless the patient is somewhat 
anaemic, when there is a slight bellows-sound on auscultation ; 
respiration is rarely affected. The general health of the pa- 
tient is frequently impaired at the commencement, or, if not, be- 
comes so in a short time ; the appetite is variable and capricious ; 
bowels constipated or irregular ; skin and kidneys fail to act 
property; patient nervous and irritable, etc. Copland remarks, 
that the disease is of long duration ; the shortest period in his 
cases was six or seven months; in one, where the interval 
between the attacks was long, it was many years. 

Causes. — In some cases we are unable to detect any predis- 
posing cause ; in many, however, there has been noticed an 
impairment of the general health, with derangement of the 
nervous system, produced by great and long continued emo- 
tional excitement, or by continued excesses. The exciting 
causes are such as produce neuralgia of other parts. 

Treatment. — For the relief of the paroxysm, the treatment 
is simple, but most efficient : #, Con. Tincture of Lobelia, 3j ; 
Con. Tincture of Macrotys, 3ij. Give 3ss every ten minutes, 
until nausea is induced. Apply a sinapism to the prsecordia, as 
hot as it can be borne, and use the hot Mustard foot-bath. 

The treatment for a radical cure varies greatly, according to 
the condition of the patient and the peculiar character of the 
disease. I might say, treat the patient on general principles; 
but this would be indefinite — and some have no principles in 
medicine. If the paroxysms recur with regularity, the patient 
living in a malarious region, we would expect to use Quinia 
with great advantage; and it would undoubtedly, in some 
cases, arrest the disease at once. Such cases, however, are 
rare. In all cases, normal action of the excretory organs 
should be obtained; the appetite and digestion, as well as the 
quantity and quality of the blood, improved by the judicious 
administration of bitter tonics and Iron, exercise in the open 
air, avoidance of emotional excitement, and a carefully selected 
diet. If there be nervous exhaustion, the use of the Hypo- 
phosphites, with a small portion of Sulphur and Quinia, is very 
beneficial. To prevent the recurrence of the paroxysms, the 
agents named for its relief would be efficient, as: #, Con. 



Angina Pectoris. 173 

Tincture of Lobelia, 3 j ; Tincture of Macrotys, gss; Tincture 
of Gelseminum, 3j ; Tincture of Aconite, 3j ; Simple Syrup, 
gvj — of which a teasponful might be administered three or 
four times a day. 

In many cases there will be found tenderness on pressure, 
over the cervical vertebra, which should be removed by coun- 
ter-irritation. The irritating plaster, applied over the region 
of the heart, has also proven beneficial. 



AUGUSTA PECTORIS. 

This disease was first fully described and named by Dr. 
Heberden, in 1768, though obscure descriptions of it may be 
detected in the earliest medical writings. The heart is the 
organ principally implicated, though the reepiratory organs 
are always involved. Much difference of opinion has existed 
in regard to the nature of the disease, some taking the ground 
that it was invariably caused by organic disease of the heart 
or arteries ; others, that it was essentially a nervous affection. 
Post-mortem examination shows, that in a majority of cases, 
there is structural lesion of either the heart or large arteries ; 
but in others, no such lesions exist. In forty-five cases, ex- 
amined by Dr. Forbes, thirty-nine exhibited disease of the 
heart or great vessels ; there was ossification or thickening of 
the coronary arteries in sixteen cases ; ossification or other 
disease of the valves in sixteen cases; ossification or dilatation, 
or both, of the aorta, in twenty-four cases; and in twelve 
cases there was preternatural softness of the heart. If we were 
not well aware that such lesions are frequently found in old 
persons, who have never exhibited the slightest symptom of 
the disease, we might look upon them as the proximate causes. 
I will, therefore, describe it simply as a nervous affection. 

Symptoms. — Angina pectoris is sometimes preceded by 
derangement of the digestive organs, deficient action of the 
excretory organs, and more or less oppression of the respiratory 
organs, which is generally spasmodic ; but it as frequently 
occurs without any premonition, when the patient is walking, 
especially when ascending a hill or flight of stairs, or at work, 
or during emotional excitement, or in the chronic form, even 
when asleep. 

In severe cases the patient is seized with painful constriction 



174 The Eclectic Practice of Medicine. 

of the chest, especially in the cardiac region. The pain 
extends to the left arm, sometimes even to the tips of the 
fingers, and amounts to excruciating agony. It is accom- 
panied with an almost intolerable sense of suffocation, con- 
vulsive dyspnoea and palpitations; always with extreme anxiety 
and a sense of impending dissolution. "When attacked, the 
patient strives to grasp some object to support him, and imme- 
diately stands still, feeling that motion would produce an 
entire suspension of living power. During the paroxysm there 
is flatulent distension of the stomach, with a feeling of irrita- 
tion, which is relieved by eructations. The pulse is generally 
weak, irregular, or intermittent; sometimes but little changed; 
rarely full, active and bounding. 

The paroxysm continues from a few minutes to one or more 
hours ; when induced by walking or other exercise, it is gen- 
erally short, but exceedingly violent; when the patient is at 
rest, especially when the disease has assumed a chronic form, 
it is long continued, but mild. When the disease is of short 
standing, the paroxysms occur at long intervals ; these are 
gradually shortened, until, in some cases, there is but little 
exemption from them. 

" The chronic form of the disease," says Dr. Copland, " is 
characterized by the circumstance of its being frequently a 
consequence of the acute; by the occurrence of the fit, from 
the slightest causes, and after short or imperfect intervals of 
exemption; by its recurrence when the patient is at rest or 
asleep; and by its much longer duration, but less extreme vio- 
lence. Even if. this form be induced by exercise, rest has but 
little influence in shortening its duration, as in the preceding ; 
and the paroxysm has been protracted, not only for some 
hours, but even for several days. Palpitation of the heart, 
irregular and intermitting pulse, are more frequently concom- 
itants of this state of the disease, than of the other." 

Causes. — This disease has been observed to occur most fre- 
quently in persons of a rheumatic or gouty constitution; in 
those who lead an indolent or sedentary life, or have been sub- 
jected to much and continued anxiety, or have been fast livers, 
guilty of such excesses as impair the nervous system and 
powers of digestion. It is a disease of the middle-aged, and 
men are far more frequently attacked than women. The di- 
gestive powers are invariably impaired, though the condition of 
the stomach varies greatly: sometimes, torpor; at others, irri- 



Inflammation of the Heart. 175 

tation; again, chronic inflammation. Digestion being imper- 
fect, nutrition of structures can not be normal, which would, in 
some degree at least, account for the structural changes found in 
the heart, and especially for the perversion of innervation, 
which is the special feature of the disease. 

Prognosis. — The prognosis may be considered favorable if 
the case is recent, and there is no structural lesion of the heart. 
If, however, the constitution is badly impaired, with organic 
disease of this viscus, a radical cure can not be effected. 

Treatment. — For the arrest of the paroxysm, the patient 
should be kept entirely quiet; warmth applied to the extremi- 
ties, if necessary; or, if circulation is impaired, friction to the 
surface, and stimulating applications to the thorax. As an 
internal remedy, I believe no agent is more efficient than the 
Lobelia. In a very severe case,- the administration of a tea- 
spoonful of the Concentrated Tincture was followed by imme- 
diate relief in two paroxysms. Tincture of Gelseminum has 
been recommended, as has also the Compound Tincture of 
Cajeput, when the circulation is very feeble. A mild purgative, 
as Compound Powder of Jalap and Senna, with some stimu- 
lating anti-spasmodic, as Tincture of Lavander, Spiritus 
Ammonise Aromaticus, Capsicum, etc., is advantageous when 
the attack is passing off. 

The treatment for the radical cure will be very similar to 
that named for neuralgia of the heart. Especial attention 
should be paid to the condition of the stomach and digestive 
organs, the excretions kept free, the quantity and quality of the 
blood improved, and those special remedies employed which 
increase normal innervation. All exciting causes should be 
studiously avoided; the patient should be temperate in all 
things. As a means of warding off the attacks, the agents 
named under the head of neuralgia may be employed with 
much advantage. 

INFLAMMATION OF THE HEAET. 

For the purpose of better describing this affection, we may 
divide it according to the character of the disease and its seat 
into — 1st, rheumatism of the heart; 2d, pericarditis; 3d, endo- 
carditis; and, 4th, carditis. It is not always possible to diag- 
nose the exact site of the disease, even when confined to one 
part, and in many cases the inflammation affects, more or less, 



176 The Eclectic Practice op Medicine. 

all parts of the viscus ; but as the treatment for each is very 
similar, it does not make much difference. 

rheumatism oe the heart. 

This is generally a metastasis of the disease, the patient 
having been affected with rheumatism of some portion of the 
body, it ceases or becomes modified, and the heart affection 
ensues. This, however, is not always the case, as it is a well 
established fact that it may attack the heart first; in some 
cases, no other portion of the body being affected. 

Symptoms. — In the mild form, the patient complains of a 
dull, gnawing pain in the region of the heart, with sometimes 
occasional sharp, darting pains, which last but for a moment; 
there is a feeling of depression and anxiet}-, that the patient 
can not account for; frequently a sensation of dyspnoea, and 
sighing respiration; in some cases the action of the heart is 
strong, with marked impulse on the thoracic walls, more fre- 
quently it is feeble, the normal sounds being much lessened. 
The pulse is frequent, from 100 to 140 per minute; stroke, 
sharp and quick, sometimes irregular. There is no heat of 
the skin; frequently, coldness and pallor of the extremities, 
with irregular action of the excretory organs. 

In severe cases, the patient experiences a violent pain in the 
region of the heart, of a lacerating or rending character; 
there is extreme anxiety, preceded or attended with chills or 
rigors. In a short time, reaction is so far established that the 
trunk becomes hot, but the extremities and face are cold, and 
the entire body is covered with perspiration, warm on the 
body, cold on the extremities. Respiration is performed with 
the greatest difficulty; the distress and agitation of the patient 
being extreme. "The patient feels every pulsation of the 
heart; rolls about to obtain ease, and presses his hand forci- 
bly against the prsecordia. The chest is elevated; the head 
thrown back; there is great thirst, but drink is refused on 
reaching the lips; and there is often loquacity, passing into 
delirium, as the disease advances." There is considerable 
variation in the pulse, but it is generally small, weak, irregu- 
lar or intermittent, and very frequent. If the disease is not 
soon arrested, jactitation comes on, there is constantly recur- 
ring fits of syncope, continued delirium, and very soon death 
terminates the sufferings of the patient. 

It will be seen from the above symptoms that the diagnosis 



Rheumatism of the Heart. 177 

is tolerably easy. The prognosis may be considered favorable 
in a majority of cases, if the treatment is prompt and well 
directed. 

Treatment. — In the mild form of the disease we employ 
the direct sedatives, as #, Tincture of Yeratrum Viride, 3j ; 
Concentrated Tincture of Macrotys, 3iij; Aquse, gvj; give a 
teaspoonful every half hour until the frequency of the pulse 
is reduced, and the patient complains of a dull, heavy pain in 
the head. 

The Mustard foot-bath, a large sinapism to the prsecordia, 
and one to the spine, immediately opposite, is very important. 
These means will mitigate the sufferings of the patient very 
much, producing profuse perspiration. Then, to remove the 
materies morbi from the system, it is essential to obtain free 
action from the kidneys. In some cases, an infusion of Hair- 
cap Moss, with the addition of Citrate or Acetate of Potassa, 
so that from 3ij to 3iij will be taken in the course of twenty- 
four hours, will answer an admirable purpose. The old-fash- 
ioned formula — #, Asclepias Tuberosa, Eupatorium Perfolia- 
tum, aa, 3j ; Sanguinaria Canadensis, 3ij ; Nitrate of Potassa, 
3ij ; pulverize thoroughly, and give in 3ss doses, every hour 
or two, until nausea is induced — is remarkably efficient in all 
forms of inflammatory rheumatism. In some cases, it appears 
almost impossible to get secretion from the kidneys, they 
being extremely congested; the symptoms are generally evi- 
dent; weight and tension in the loins; dull, heavy pain in the 
back; and a disagreeable sensation of heat and tenesmus in 
the urinary passages. In such case, we apply active counter- 
irritation to the loins, and for further relief, prescribe a brisk 
cathartic, as #, Podophyllin, grs. iv; Bitartrate Potassa, 3ij; 
make three powders, and administer one every four hours. 

In a severe case, our measures must be more active, and 
are somewhat different; here, it will not, as a general rule, 
answer to use sedatives, until the heart acts regularly. I com- 
mence the treatment by the application of six or eight cups 
over the prsecordia, drawing them well, and scarifying; apply 
to the entire lower extremities flannel cloths wrung out of a 
hot infusion of Mustard, changing them every ten or fifteen 
minutes. Internally, one of the cathartic powders named 
above, and #, Concentrated Tincture of Macrotys, 3iij ; Tinc- 
ture of Lavandula Comp., 3ij; Syrupus Simplex, 3iij; M., and 
give a teaspoonful every hour. 
12 



178 The Eclectic Practice of Medicine. 

In the course of five hours, the patient can be turned upon 
his side, when I direct cups and scarification to the spine, over 
the entire dorsal region; the number applied depending upon 
the severity of the case. Then we can commence the use of 
the direct sedatives, and the additional treatment recom- 
mended for the mild case. The object we wish to obtain by 
the active treatment recommended above is temporary relief 
for the over-burdened heart. That it will not do to use seda- 
tives at first, is proven to my satisfaction by the fatal termina- 
tion of three cases which have come to my knowledge, and 
one under my own observation, in which Veratrum was used 
at the commencement. The means I recommend will relieve 
the over-burdened organ, and then sedatives can be employed 
without danger. 

In chronic rheumatism of the heart, I employ Veratrum 
and Macrotys, in suitable doses ; the irritating plaster to the 
prsecordia, and, if there is tenderness on pressure, to the 
spine; Citrate or Acetate of Potassa, as a diuretic; the daily 
use of the alkaline bath; the bowels to be kept in a soluble 
condition; and suitable bitter tonics and Iron, to improve the 
quantity and quality of the blood. 



PERICARDITIS. 

Symptoms. — Very frequently the disease is ushered in by a 
marked chill or rigor, though sometimes it is difficult to detect. 
To this succeeds febrile reaction; the skin becomes hot, though 
perspirable ; the pulse is generally full, strong, hard, and fre- 
quent ; the urinary secretion is somewhat arrested, and bowels 
constipated. Considerable oppression at the prsecordia is felt, 
with much anxiety, which constantly increases. A more or 
less acute pain is experienced under the left nipple, sometimes 
so severe as to render respiration extremely difficult ; there is 
tenderness on pressure over the heart. The pulsations of the 
heart are much stronger than usual, sometimes regular, though 
frequently irregular, tumultuous, unequal or intermittent ; fre- 
quently, paroxysms of palpitation, when the impulse can be 
readily felt by the hand. By the end of the second day, we find 
that the feeling of oppression and anxiety has so increased as to 
be almost insupportable. The pulse is unequal, oppressed, 
irregular, small and rapid, often intermittent. The skin is either 



Carditis. 179 

hot, dry, and constricted, or an increased heat of the trunk, with 
coldness of the extremities, which are frequently covered with 
a cold, clammy perspiration : sometimes nausea and vomiting 
come on, which, to some extent, obscures the disease ; in 
other cases, a severe singultus occurs, greatly aggravating the 
sufferings of the patient. If the adjoining pleura is impli- 
cated, respiration is hurried, short and shallow, sometimes 
interrupted by broken sighs, or by deep catchiug inspirations. 
Sometimes, in this stage, there is noticed a diffused rumbling 
sound, resembling the to-and-fro sound in pleuritis ; frequently 
there is a more or less marked bellows-sound. 

With the appearance of effusion — which may occur at any 
period from the first to the fourth day — we notice an increased 
dullness on percussion, and diminution of the sounds of the 
heart on auscultation. If there is much effusion, there is 
marked and extensive dullness on percussion; a weak and dif- 
fused impulse of the heart; a small, weak, irregular pulse, 
and extreme or constant dyspnoea. Very frequently the coun- 
tenance becomes tumid, bloated and livid. Motion induces 
faintness or syncope, the pulse nearly disappearing. 

Sometimes the general symptoms are very light during the 
entire course of the disease, there being but the anxiety and 
oppression, with occasional lancinating or tearing pains, and 
increased frequency and irregularity of pulse to mark the 
progress of the disease. 



CARDITIS. 

Symptoms. — The patient experiences a violent pain in the 
region of the heart, with anxiety, preceded or attended by 
rigors, chills, or tremblings of the whole frame. To these 
succeed increased heat about the praecordia, or in the trunk, 
while the extremities and face are cold, and the whole surface 
is covered by perspiration, which is cold on the extremities. 
The pain is concentrated in the situation of the heart, is lacer- 
ating or rending, accompanied by the utmost agitation and 
expression of anxiety and distress; sometimes by screams, and 
occasionally by general convulsions or swoonings. The 
patient feels every pulsation of the heart, rolls about to obtain 
ease, and presses his hand forcibly against the praecordia. 
The chest is elevated, the head thrown back; there is great 
thirst, but drink is refused on its reaching the lips; and there is 



180 The Eclectic Practice of Medicine. 

often loquacity, passing into delirium as the disease advances. 
The pulse varies remarkably, but is generally unequal or irreg- 
ular, and remarkably small and weak, or indistinct. If the 
disease is not soon arrested, constant jactitation or tremor, 
recurring fits of syncope, delirium, and death, take place. 



ENDOCARDITIS. 

Symptoms. — If the inflammation is confined to the endo- 
cardium, actual pain is seldom felt, the patient complaining 
of oppression or anxiety in the prsecordia, with faintness. It 
is ushered in by a slight chill, but febrile reaction is not very 
well marked. The physical signs, says Dr. Copland, require 
the closest attention: "1. The precordial region, in simple 
endocarditis, is shaken by the violence of the heart's action, 
the hand being forcibly resisted by the impulse, when applied 
over this region. The pulsations are felt over a greater extent 
than natural, owing to the turgescence of the organ in an 
inflamed state ; and a vibratory tumor, more or less marked 
is also sometimes felt. 2. Percussion furnishes a dull sound 
over a greater extent of surface than natural — from four to 
nine or twelve square inches. But in order to distinguish this 
sound from that attending effusion into the pericardium, it is 
necessary to observe that it coexists with a visible, superficial, 
and sensible pulsation of the heart; the last being profound, 
and hardly visible or sensible in pericarditis with effusion. 
3. Auscultation detects a bellows-sound, which marks the true 
normal sounds, or one of them only. The sound is the louder, 
the stronger the action of the heart; and is also rougher, the 
greater the swelling of the valves, and the more abundant and 
concrete the exudation of lymph from the inflamed surface. 
Sometimes, when the palpitations are violent, a metallic sound, 
isochronous with the systole of the ventricle, is heard. 4. The 
force of the heart's contractions is changed, both to the eye 
and touch, and the frequency equally affected; the pulse rising 
sometimes as high as 140 and 160, or even higher, in a minute, 
and becoming irregular, unequal or intermittent. 5. Animal 
heat is generally also increased, but not usually in proportion 
to the augmentation of the circulation. The arterial pulsations 
represent the frequency, but not the strength of the heart's 
action in this disease; for, while the contractions of the heart 



Endocarditis. 181 

are energetic, the pulse is generally small, soft, and indistinct. 
This is owing to the obstacle opposed to the circulation by the 
sucking of the valves or orifices, or both, or by the fibrinous 
exudations formed around them — a smaller quantity of blood 
being thrown into the arterial trunks ; hence, probably, arise 
the pallor, anxiety, jactitation, faintness, leipothymia, want of 
consciousness, etc., so frequently observed." 

If the venous circulation is obstructed, the dyspnoea is greatly 
increased, the face is bloated and livid, and oedema appears. 
In such case, the patient experiences the most distressing 
oppression; can not lie down in bed; is watchful, restless, and 
subject to constant jactitation. 

Post-Mortem Appearances. — In pericarditis, when death 
occurs early in the disease, there is frequently nothing but red- 
ness and injection of the pericardium; sometimes the redness 
is increased by infiltration of minute quantities of blood into 
the adjacent tissues, so as to give rise to ecchymosis, or red 
spots. In the stage of effusion, there are various appearances; 
the effused fluid usually separates into a turbid of flocculent 
serum, and a concrete or fibrinous false membrane. In some 
instances the effusion consists of a well-formed pus ; in others 
there is no fluid, the exudation forming false membrane, and 
fibrinous adhesions between the free surfaces of the pericar- 
dium. The effusion in pericarditis varies from one to two 
ounces to as much as four pounds. 

In carditis, the structure of the heart is discolored reddish- 
brown, softened and injected. Sometimes, but rarely, there 
has been observed collections and infiltrations of pus. Some- 
times there is softening, the heart being whitish, grayish, or 
yellowish. 

In endocarditis, there is sometimes but little evidence of the 
disease, beyond slight thickening and softening of the mem- 
brane, which is more easily separated from the muscular 
structure. Occasionally there is great contraction of the open- 
ings, and thickening of the valves. Frequently the forma- 
tion of fibrinous concretions from the orifices, . valves, or 
internal surface. 

Diagnosis. — The diagnosis must be in part by. exclusion; 
then we have the prominent symptoms, continued pain or 
anxiety in the region of the heart; palpitations; a tendency 
to syncope, or faintness; dyspnoea; acceleration ancLirregular- 
ity of the pulse; with symptomatic inflammatory fever.. As> 



182 The Eclectic Practice of Medicine. 

has been before remarked, we rarely find the inflammation 
confined to one tissue ; hence we have to take the aggregate 
symptoms of the three forms of inflammation, to establish the 
diagnosis. 

Prognosis. — Though the disease is one of the most severe to 
which mankind is liable, yet the prognosis may be considered 
favorable, if prompt treatment is adopted in the early stage. 
The sequela? of the disease embrace nearly the entire list of 
chronic structural diseases. 

Treatment. — The treatment of inflammation of the heart, 
must be prompt and decisive; the first indication being to re- 
lieve it by getting determination of blood to other parts, and 
lessening irritation. To fulfill this, I direct the application of 
cups to the prsscordia, with scarification, if the case is severe, 
following with fomentations of Lobelia. The extremities 
should be wrapped in cloths wrung out of Mustard-water, as 
hot as they can be borne ; and these should be continued until 
free circulation is established. If there is nothing to contra- 
indicate, give, at the commencement, a cathartic, as #, Po- 
dophyllum, gr. j ; Bitartrate of Potassa, grs. xx, and repeat, 
every four hours, until the bowels are freely moved. To 
lessen irritability of the heart, no agents are better than #, 
Tincture Lobelia, Tincture Macrotys, Compound Tincture 
Lavender, aa, administered in drachm doses, every hour or 
two hours. 

Frequently, much benefit is obtained from brisk counter- 
irritation, the entire length of the spine. To assist the action 
of the other remedies, and as a diluent, use freely an infusion 
of Asclepias Tuberosa. These means should be continued 
until the circulation becomes free, and the action of the heart 
regular ; then put the patient upon the use of special seda- 
tives, Veratrum and Aconite, in small closes, largely diluted, 
and frequently repeated. Still use the infusion of Asclepias, 
adding to it such a quantity of Acetate of Potassa, that the 
patient will take about 3iij in the course of twenty-four hours. 
A weak Mustard hand-bath should be employed once or twice 
per day, and counter-irritation to spine and prrecordia con- 
tinued, until the patient is convalescent. Other treatment, 
after the inflammation is arrested, will have to be left to the 
good judgment of the practitioner, meeting the indications as 
they arise. 



Chronic Structural Disease. 183 

CHROjSTIC structural disease. 

There is a large class of cases in which the health is slowly 
impaired, and death eventually induced, hy derangements of 
the circulation, which depend on organic changes of the 
heart. These changes affect its contractile power and its 
valvular apparatus. The principal of these organic lesions 
are, hypertrophy, attenuation, and structural alteration of the 
muscular walls of the heart, on which its contractile powers 
depend ; and valvular derangements, which either interfere 
with the perfect closure of the different orifices of the heart, 
and thereby permit a regurgitation of the blood, or else offer 
obstacles to the onward flowing of the blood in its normal 
direction. 

These diseases are diagnosed principally by physical signs, 
the most important of which are obtained by auscultation. 
During the healthy action of the heart, if the ear is applied 
to the prsecordia, two sounds are heard. t The first is synchro- 
nous with the pulse, is long and muffled ; the second imme- 
diately follows, and is short and clear; then a pause, and they 
are repeated. The first has been termed the systolie sound, 
and is undoubtedly produced by the contraction of the ven- 
tricles; the second — the diastolic sound — is produced by the 
back stroke of the blood and the unfolding of the semi-lunar 
valves. These sounds recur with the greatest regularity 
during the healthy action of this viseus, so that alterations in 
its rhythm become evidences of diseased action. They become 
more intense, if the walls of the thorax are thin and elastic; 
or if the spongy texture of the lung is replaced by solids or 
liquids; or if there is excessive contraction of the walls of 
the heart. They are less intense, if the heart is farther re- 
moved from the thoracic wall, or by thickening of the same; 
or if there is defective contraction of its walls. They are chang- 
ed in character, or replaced by adventitious sounds, by changes 
in the blood — which would impair its circulation — by changes 
in its muscular parieties, and especially by structural altera- 
tion of its orifices and valves. These sounds may be loud or 
feeble, clear or muffled, extended, distant, ringing, etc. 

The principal adventitious sounds, are the bellows sound, 
the rasp sound, saw sound, and file sound. The first, or bellows 
murmur, may be the result of several lesions, as — 1st, of 
dilatation of one or more of the heart's orifices, with deficien- 



184 The Eclectic Practice of Medicine. 

cy of the valves, and consequent regurgitation of the blood ; 
3d, anemia, with defective action of the heart ; 3d, polypoid 
exudations resulting from inflammation ; and, 4th, irregularity 
or roughness of the surface of the valves, or vegetations, or cal- 
careous formations within or upon them. The three sounds last 
named, are produced by such structural changes of the orifices 
and valves as give rise to unnatural motions in the current of 
the blood circulating through the heart. 



HYPERTROPHY OF THE HEART. 

Hypertrophy of the heart exists in two forms, with and 
without dilatation of its cavities ; the first is of far more fre- 
quent occurrence. It may also be confined almost entirely to 
one cavity, as in hypertrophy of the left ventricle, from ob- 
struction of the aortic opening. The causes of hypertrophy 
are such as will increase nutrition, as continued determination 
of blood, the result of inflammation, rarely excessive innerva- 
tion, and obstruction of the free passage of the blood from the 
heart, which necessitates an increased power, and a consequent 
excess of nutrition. In almost all cases, it is associated with 
other disease. 

Symptoms. — The local signs of the disease consist principally 
in an increased force of the heart's contraction, manifest by a 
more extensive and enduring impulse felt in the cardiac region, 
an increased dullness on percussion, and an increase of the 
sounds. The extent of dullness on percussion is not as great 
in simple hypertrophy, as it is in hypertrophy with dilatation ; 
the sounds are likewise more prolonged and dull in the first 
than in the last ; frequently, in hypertrophy with dilation, the 
sounds are remarkably clear, loud and short. 

If there is no other marked structural change than the hy- 
pertrophy, the general symptoms are such as would arise 
from an excess of force in the circulation of the blood; 
sometimes, apoplectic symptoms, tendency to active hemor- 
rhage, etc. * 

Treatment. — The treatment of this condition is principally 
hygienic. The patient should be placed on an unstimulating 
diet, rather scanty than otherwise; excessive exertion should 
be carefully avoided, and all the secretions kept free. The 
object is, to reduce the quantity of nutritient material in circu- 



Disease of the Valves. 185 

lation to the lowest quantity compatible with health, and to 
remove, as far as possible, any cause of excited action of the 
heart. If there should be irritation of the organ, counter- 
irritation is the most efficient means for its removal. 



ATTENUATION OF THE WALLS OF THE HEART. 

This is a very rare affection, in any considerable degree, 
without dilatation, as the nutrition of the heart is seldom so 
much impaired, even when other muscular structures suffer 
greatly. The evidences of it are very obscure during life, 
being nothing more than want of power in the circulation of 
the blood. The same tonic and stimulant plan of treatment 
we would adopt in defective nutrition of other parts, would be 
applicable here. 

Attenuation with dilatation is of more frequent occurrence, 
the symptoms being, according to Copland, " slight palpita- 
tions, with dyspnoea and cough ; the impulse of the heart being 
weak and diffused; the sounds being louder, clearer, shorter, 
and heard over a larger extent of the chest than natural ; and 
the pulse being weak, small and irregular." The treatment — 
so far as we can treat it — is obvious; improve the general 
health and tone of the system, by the judicious use of bitter 
tonics, Iron, the use of nutritious food, exercise in the open 
air, etc. 



ALTERATIONS IN THE STRUCTURE OF THE HEART, 

Fatty degeneration, softening, calcareous degeneration, 
etc., — can rarely be detected during life. The symptoms, if 
any exist, are those of debility, which would indicate the 
proper treatment. These cases frequently prove suddenly 
fatal, without any, or but little, premonition. 



DISEASE OF THE VALVES. 

We may properly divide disease of the valves of the heart 
into two classes : first, where, from contraction of the orifice, 
or change in the structure of the valves themselves, the free 
passage of the blood is prevented; and, second, where 



186 The Eclectic Practice of Medicine. 

the valves are insufficient to close the opening, permitting 
regurgitation. 

Obstruction to the passage of blood through the orifices, is 
generally attended with the development of one of the adven- 
titious sounds — L e., the saw, rasp and file sounds, — especialty 
if in any considerable degree ; if not, the alteration is merely. 
a roughing of the natural sounds of the heart. The general 
symptoms depend somewhat upon the situation of the disease. 

The left auriculo- ventricular opening is most frequently in- 
volved . The cause of the obstruction may be, contraction of the 
opening, thickening of the valves, fibroid vegetations, cartila- 
ginous or ossific formations, from or within their structures. If 
the obstruction is considerable, the blood can not pass freely 
from the lungs; hence, congestion, apoplexy, and hemorrhage 
of the lungs, are of frequent occurrence. In these cases, all the 
general symptoms sometimes point to the lungs as the seat of 
the disease; the cough, expectoration, dyspnoea, etc., seem 
sufficient evidence on superficial examination. The morbid 
sound, heard on auscultation,- is either a saw, rasp, or file 
sound, or a roughened bellows murmur, not very intense ; it 
is most intense at the left side of the sternum, between the 
third and fourth ribs, and occurs at the time of the production 
of the second natural sound. 

Obstruction at the aortic orifice generally causes enlargement 
of the heart, with hypertrophy, especially of the left ventricle. 
When in considerable degree, the pulse is small and weak, 
and the general symptoms such as would arise from obstructed 
circulation of the blood. If the entire heart is hypertrophied, 
the contractions necessarily being forcible, the vis a tergo of 
the blood from the right side to the lungs is markedly increased, 
and its free passage from them being obstructed by the dimin- 
ished aortic opening, we frequently have hemoptysis, cough, 
increased expectoration, and other evidence of disease of the 
lungs. In either of these cases, dropsy may result, if the 
patient becomes debilitated. This obstruction is evidenced by 
a bellows sound, which is superficial, occasionally sibilous, 
marking or replacing the first natural sounds. If it arises 
from vegetations from the semi-lunar valves, or cartilaginous 
or ossific formations within, then the sound is generally a saw 
sound. These sounds can generally be heard for some distance 
over the larger arteries. 

Obstructions of the right auriculo- vehicular orifice, is next 



Arteritis. 187 

in frequency. It is evidenced by a deep blowing or filing sound, 
most distinct under the junction of the fourth rib with the 
sternum ; it replaces the second natural sound. In this case, 
there being obstruction to the free passage of venous blood, 
we find the jugular veins prominent, and when severe, evi- 
dence of general venous congestion. Dropsy is a very frequent 
result, when the general health becomes impaired. There is 
rarely obstruction at the pulmonary orifice. 

Insufficiency of the mitral valves occasions a morbid sound of 
either of the three characters named, and is heard at the time 
of the first natural sound. The pulse is always irregular and 
intermittent, with general symptoms of disordered circulation, 
In some cases, the lungs suffer in a remarkable degree. 

Insufficiency of the aortic valves, is marked by a short, 
whiffling, or rasp sound, replacing the second natural sound. 
The impulse of the heart is generally strong and heaving, with 
strong pulsation, and sometimes purring thrill over the carotid 
arteries. This affection — as is the case with most heart dis- 
eases — precludes the possibility of laborious exercise, though 
frequently the general health is but little affected. 

Insufficiency of the tricuspid valves, is marked by either a 
saw, rasp, or bellows sound, which replaces the second natural 
sound. Owing to regurgitation, and consequent obstruction 
to the venous circulation, there is distention of the jugular 
veins, with 'pulsation. In this disease there is marked venous 
obstruction. The health is considerably impaired, and dropsy 
of very frequent occurrence. 

Treatment. — The treatment of these forms of heart disease 
has to be conducted on general principles; the indications have 
to be met as they present themselves. In all cases, we direct 
the patient to use the utmost precautions to prevent any un- 
due excitation of the organ ; quietude and time do more than 
medicine. It is important that the patient should be so placed 
that he can enjoy the best possible health. In obstruction, we 
find it useful to resort to the salts of Potassa and alteratives — 
to remove deposits, keeping the excretions free. 



ARTERITIS. 

The symptoms of disease of the arteries are very obscure, 
and it is doubtful whether it is possible to determine clearly 
during life. If confined to a single limb or portion of the 



188 The Eclectic Practice of Medicine. 

body, the symptoms are so like inflammation of the part that 
the two can not be distinguished. If, however, the disease 
results in obstruction of their canals, the tendency to sphace- 
lus, manifested by the appearance of large bullae, imperfect 
circulation of the blood, etc., with rigors and marked prostra- 
tion, may lead us to suspect this condition. 

The symptoms of general arteritis, according to Copland, 
are : rigors, followed by fever, great anxiety, irritability, rest- 
lessness, uneasiness, a sensation of burning heat, remarkable 
pulsation, with increased sensibility in the course of the large 
arteries. The patient complains of marked throbbing through- 
out the system, the surface is hot, tumid and injected; the 
tongue red, its papillse erect, and base loaded ; the bowels are 
costive; thirst urgent; urine scanty, high-colored and scald- 
ing. The pulse is strong, throbbing, full and frequent; and 
there is sometimes paroxysms of cough and dyspnoea. 

In the second stage of the disease the pulse becomes very 
frequent, wiry, weak and irregular. There are palpitations, 
anxiety, and severe paroxysms of dyspnoea; the tongue is 
coated with a dark fur, and sordes appear on the teeth; the 
countenance shrinks, and is pallid and haggard, or towards the 
last becomes bloated, oedematous, and the lips purple. These 
symptoms increasing, hiccough, jactitation and convulsions 
make their appearance, and the patient is soon worn out. 

Treatment. — This disease, so rare in its occurrence, and 
diagnosed with such difficulty, has had no definite treatment 
laid down, as yet. In the first case, of local arteritis, the 
use of warm sedative or narcotic fomentations, in the first 
stage of the disease, with the internal use of sedatives, an 
alkaline diuretic, and hydragogue cathartic, would seem to be 
advisable. Where, however, the symptoms pointed to loss of 
vitality, the internal administration of Tincture of Muriate of 
Iron, with tonics and stimulants, and the local application of 
the first named agent diluted, or a dilute solution of Sulphate 
of Zinc would be appropriate. 

In the general disease, in the first stage, the warm bath, 
at 90° to 100°, or the vapor bath, with the special sedatives 
as named under the head of fever, followed by Quinia, I 
should judge to be judicious. Possibly the wet sheet pack 
might be used with advantage. In the second stage, it does 
not seem that treatment would be of much advantage, but we 
might adopt that named for typhus fever. 



Aneurism. 189 

ANEURISM. 

The treatment of aneurism more properly belongs to the 
surgeon, and I only notice it here, as it affects internal parts, 
that are out of the reach of surgical aid, but require the 
assistance of the physician if for nothing but the palliation of 
the unpleasant symptoms. 

Nervous Pulsation, Simulating Aneurism. — This occurs 
chiefly in feeble, delicate persons, when there is much emacia- 
tion, and is usually associated with disease of parts immedi- 
ately upon or adjacent to the spot where the pulsations occur. 
It is generally confined to the aorta, and more frequently 
appears in the epigastrium than at any other point. The sen- 
sation is extremely unpleasant, and the marked pulsation sim- 
ulating aneurism calculated to very much alarm the patient. 
In addition to this the general health is usually impaired, 
so that the influence upon the nervous system k much more 
marked. 

We determine the difference between this and an aneurism 
by the fact that the pulsation is jerking and sudden, and 
rarely diastolic, like an aneurismal tumor, but strikes upward 
as the patient lies on the back, and if diastolic not to an 
extent greater than the caliber of the artery. It is not a cir- 
cumscribed, but rather an elongated pulsation, sometimes 
occupying the whole line of vessel; and in many cases it dif- 
fers from the throbbings of an aneurism in this, that its inten- 
sity increases from above downwards, and has its maximum 
at the umbilical region, and that its force and character are 
continually varying. 

The causes of this pulsation, according to Dr. Mott, are: 
enlargement or disease of the pancreas, scirrus of the stom- 
ach, particularly of its pyloric orifice, tumors at the foot of 
the mesentery, nervous irritation, enlargement of the vena 
cava inferior, increased solidity of the lungs, enlargement of 
the heart, particularly a dilatation of its right side, adhesion 
of the pericardium of the heart. 

Treatment. — The treatment adapted to these cases should 
be such as would improve the quantity and quality of the 
blood, and restore the nervous system to its normal condition. 
The bitter tonics, especially such as remove irritation of the 
mucous surfaces, as the preparations of Hydrastis, Cornus, 
Populus, etc., with Carbonate of Iron, are advantageous. 



190 The Eclectic Practice of Medicine. 

Hydrocyanic Acid, or, what is better, the infusion of Peach 
Bark, heretofore named, is an admirable agent in cases where 
the disease is located at the epigastrium, and the stomach is 
irritable, as is also the Collinsonia, Ptelea, and Euonymus. If 
there is undue excitation of the pulse, #, Ferrocyanuret of 
Potassa, 3j; Tincture Aconite, gtt. xx; Aqua, 3iv; M., and 
administer in doses of ateaspoonful every three or four hours. 
If there is irritation of the spinal cord, marked by tender- 
ness, the irritating plaster or other means of counter-irritation 
should be used until it is removed. Any disease of parts 
adjacent to or connected by sympathy with the region of pul- 
sation, should be appropriately treated. A daily bath suitable 
to the case should be employed, as a normal action of the skin 
is very beneficial in these cases; regular exercise in the open 
air should be taken, and a light but nutritious diet recom- 
mended. 

* THORACIC ANEURISM. 

This occurs far more frequently at the arch of the aorta 
than in any other part. It presents varied symptoms in dif- 
ferent persons, sometimes giving rise to severe suffering, at 
others occasioning but very little. The rapidity of growth 
varies very greatly, in some cases running its course in a few 
weeks, again lasting for years. At first, it gives rise to but 
little disturbance, but as it increases in size, the pressure on 
adjacent parts causes unpleasant and sometimes very severe 
symptoms. Usually the respiratory apparatus is most affect- 
ed, and more or less difficulty of breathing is experienced ; 
this is very great in some cases where the pressure is against 
the trachea. As the tumor enlarges, it forces the lungs to one 
side, and makes its appearance under the thoracic wall; 
gradually the pressure causes absorption, and it becomes very 
apparent; and it may continue until it forms a long, external, 
pulsating tumor. Being situate further back, it causes more 
disturbance, and is more difiicult of diagnosis. It is in these 
cases that we have such extensive absorption of soft parts, and 
of the bodies of the vertebra. 

Diagnosis. — This is formed from the general symptoms, 
which indicate the seat of the disturbance, and from ausculta- 
tion and percussion. In those cases in which the tumor makes 
its appearance anteriorly, the diagnosis is easy, and these are 
the only cases in which it is so. In others, if in front, we find 



Aneurism. 191 

dullness, on percussion, and in any case a deep, double sound, 
louder than a bellows murmur, and of a rasping character. 
If the ear applied to the back detects an abrupt rasping sound, 
synchronous with the pulse, there is aneurism. 

ANEURISM OP THE ABDOMINAL AORTA. 

This is usually not difficult to determine, though it is some- 
times very obscure. According to Copland, it is attended with 
acute pain, occasionally shooting into either hypochondria, 
and downwards into the thighs and scrotum. It is often 
exacerbated into violent paroxysms, being dull and fixed at 
intervals ; it is aggravated by constipation, changes of posi- 
tion, and pressure on the loins. The patient often complains 
of severe fits of colic, accompanied with spasms of the abdo- 
minal muscles, and occasionally nausea and irritation of the 
stomach. Constipation is always present. The physical signs 
are the same as heretofore named, the purring thrill, pulsa- 
tion, and harsh, bellows sound, synchronous with the heart's 
action. 

Treatment. — A rational treatment of these cases would be 
such as would insure the greatest quiet of the circulation, and 
at the same time keep the blood rich in the elements of nutri- 
tion. Strict quietude of mind and body should be insisted 
on, though in the earlier stage of the affection moderate exer- 
cise by walking in the open air should be recommended. A 
light, nutritious and easily digested diet, avoiding stimulants 
of all kinds, is necessary. Spontaneous cure takes place by 
continual deposition of coagulable lymph, and fibrinous 
coagula in the aneurismal sac ; if the vital energies are taxed, 
or the circulation is disturbed, this can not occur. 

When the circulation has too much force, or is too rapid 
from the irritation, the judicious use of small doses of Tincture 
of Veratrum or Digitalis proves advantageous. If neuralgic 
pains supervene, Extract Conii with Tincture of Macro tys is 
useful. Local pain may be relieved by the Chloroform and 
Aconite Lotion applied to the part. In abdominal aneurism 
the bowels should be kept in a soluble condition, and the pain 
relieved by the administration of the milder narcotics. In 
two cases that have come under my notice (both epigastric) 
more relief was given by the application of the irritating 
pi aster, continued so as to produce gentle counter-irritation, 
than by any other means. 



192 The Eclectic Practice of Medicine. 

PHLEBITIS. 

Inflammation of the veins is of much, more frequent occur- 
rence than of the arteries ; it is likewise marked by tolerably 
prominent symptoms. It is caused by wounds, injuries, local 
inflammation, disease of the bones or affections of the skin, 
giving rise to the formation of pus. It is of quite frequent 
occurrence as an element of puerperal fever, but excluding 
these cases the male is much more liable to it than the 
female. 

Symptoms. — Where the superficial veins are affected, the 
symptoms are very manifest, but not so distinct when the 
deep-seated are affected. It usually commences with a severe, 
sharp pain along the course of the vein or veins, which if 
superficial will become hard and tense, seeming under the skin 
like a hard, knotted cord. At the same time the skin presents 
a reddish line along the course of the disease, which some- 
times changes to purple. Congestion and hardening of the 
adjacent parts take place, and if one or more large trunks are 
affected, the parts become oedamatous and very much swollen. 

The constitution sympathizes more or less with the disease ; 
usually there is a chill — sometimes a marked rigor at the com- 
mencement — followed by fever of a remittent type. All the 
secretions are deranged ; there is loss of appetite, headache, 
and considerable prostration. If promptly treated, in favora- 
ble conditions of the system, the disease goes no further, the 
coagula formed in the veins become organized ; a collateral 
circulation is established and the inflammation ceases. In 
other cases the vein secretes pus, and pus is formed in the ad- 
jacent deposit, the result being the formation of an abscess. 
Or the vein secreting pus, the purulent matter is carried into 
the general circulation, the system becomes infected, and we 
have the low form of fever and other results, which will be 
noticed hereafter, under the head of pyaemia. 

Diagnosis. — Phlebitis of superficial veins may be readily 
diagnosed by the cord-like hardness in the course of the vein, 
redness of the surface, and pain and tenderness on pressure. 
Of the deep-seated veins we can not judge so readily, though 
the presence of symptoms of inflammation for a considerable 
distance and not affecting the tissues generally will be pretty 
good evidence. 

Prognosis. — The prognosis is not unfavorable, unless the 



Phlebitis. 193 

blood has been changed by some previous disease, so as to pre- 
dispose to the formation of pus, when it becomes one of the 
most fatal affections known. 

Treatment. — Prompt treatment saves a great amount of 
trouble in these cases, and renders the occurrence of the sup- 
purative stage less liable to result. If symptoms of severe 
constitutional disturbance are present, the administration of a 
thorough emetic is advisable, to be followed by diaphoretics 
and diuretics. If the bowels are constipated, a mild cathartic 
of Podophyllin and Leptandrin may be given, but if there is 
tendency to diarrhoea give the Neutralizing Cordial in sufficient 
quantity to move the bowels once or twice, and then in small 
doses to check them. 

After the use of the emetic, Quinia to the amount of from 
eight to fifteen grains, should be given daily in the period of 
greatest intermission. Brandy, Wine, and especially malt 
liquors, are useful in cases where there is much prostration, 
and may be given in quantities sufficient to produce the neces- 
sary stimulation. 

As regards local applications there is some dispute. Some 
recommend warm applications, others cold ; some stimulant, 
others sedative; so that the reader would have difficulty in 
making up his mind what would be proper. Of one thing we 
are certain, and that is, if there is the slightest evidence of ac- 
cumulation of pus in the part from which the vein comes, let 
it out, by a free incision. If a wound, it must be reopened ; 
if from fractures, the incision should reach the bone ; if in 
amputation, any part that seems baggy should be incised; in 
these cases, the free use of the knife is oft-times better than 
any medicine. If the inflammation is of the superficial veins, 
the application of the Tincture of Muriate of Iron with a 
camel's-hair pencil the entire length of the vein, has with me 
answered a better purpose than any other means ; I employ it 
freely and three or four times a day. Two or three thicknesses 
of soft cotton cloth may then be wet with Tincture of Aconite, 
3j ; Tincture of Arnica, 3ij ; Fluid Extract of Belladona, 
3ss ; and laid over the course of the vein. "Where the disease 
is deep-seated, the application of Vinegar cold, is probably as 
good as anything, unless the pain is severe, when I would 
recommend a poultice made of a decoction of Cornus Florida 
and Wheat bran. 

I am inclined to believe that the Muriated Tincture of Iron 
13 



194 The Eclectic Practice of Medicine. 

exerts a specific influence in this disease, and in the few cases 
that have come under my notice have given it in doses of 
twenty or thirty drops every four hours. 



PYEMIA. 

This is the second or suppurative stage of phlebitis, in 
which pus being formed in the veins is carried into the circu- 
lation and induces the severe symptoms below named. The 
pathology of the disease is not definitely settled, much dis- 
crepancy of opinion having existed. Pour theories are named 
as accounting for the phenomena. 1st, That it is owing to the 
admixture of the pus with blood, the pus-cells being larger 
than those- of the red globules are arrested by the minute capil- 
laries, and give rise to secondary abscess. 2d, That it depends 
upon the property of pus to coagulate the blood, which occur- 
ing occludes the capillaries of a part, and thus gives rise to 
abscess. 3d, That it is owing to some irritant body, which 
inducing capillary phlebitis, gives rise to the secondary sup- 
puration. 4th, That it is caused by a peculiar poison which 
contaminates the system. 

If we examine the cases of this disease closely, we find that 
in all there was unmistakable phlebitis, running or tending to 
the production of pus, and the inference is natural, that this 
is the cause of the mischief. That it does not affect the sys- 
tem, as in- the first proposition, is proven by the fact that the 
white globules of the blood are as large as pus-cells, and can 
with difficulty be determined from them; and yet these readily 
pass the rounds of the circulation. That the second proposi- 
tion is not a true explanation, is proven by the fact that pus 
does not coagulate the blood in living vessels, though it 
quickens it when drawn. In answer to the third, it is claimed 
and proven that normal pus is one of the most bland and in- 
nocuous of animal fluids, and by direct experiment that no 
such results follow its introduction into the blood vessels. The 
fourth proposition is defensible from the fact that we know 
that animal matter undergoes changes which render it emi- 
nently poisonous, as exampled by variolus pus, the matter of 
glanders, certain septic changes in decomposing animal matter, 
which render it peculiarly dangerous, as malignant pustule, 
certain dissecting wounds, etc. "We can not account for the 



PYiEMIA. 195 

production of this poisonous pus at one time and the bland 
innocuous fluid at another ; neither can we always distinguish 
between them, any more than we can account for the produc- 
tion of small pox, or vaccine virus, or distinguish between 
them. 

Symptoms. — Though pysemia may result from the phlebitis, 
as heretofore described, yet in a majority of cases the severe 
symptoms are manifested at the commencement. The forming 
stage is generally very short, usually not more than twenty- 
four hours, during which the patient feels languid, and if 
from an injur} 7 or operation, complains of severe pain in the 
part. A violent chill or rigor now occurs, lasting from fifteen 
minutes to one or two hours, succeeded by violent reaction, 
and this by profuse perspiration. The rigor happens some- 
times several times a day, at others but once, and occasionally 
none after the first one. 

The symptoms are always severe when the disease is once 
established; the pulse is small, frequent and feeble; the 
mouth clammy, and the tongue covered with a dirty, brown- 
ish coat ; the stomach is irritable, and nausea with vomiting 
occurs from slight causes ; the bowels are irregular, the evacu- 
ations being dark and very offensive; the urine is high- 
colored, scanty and foetid ; the extremities are cool; the trunk 
hot and pungent; the mind wanders, and the patient has 
little command over the voluntary muscles ; there is tenderness 
of the entire body, and sometimes excruciating pains in 
internal organs and joints. These symptoms increase day by 
day, bearing a marked analogy to the severest cases of 
typhoid fever. 

Sooner or later in the disease the poison seems to localize 
itself by lighting up an inflammation of the lungs or other 
viscera, of the joints, and of various soft parts. These inflam- 
mations run a rapid course, and always terminate in suppur- 
ation, sometimes several parts being affected at the same time, 
or innumerable small absessces form in various parts of the 
body. , 

Diagnosis. — The symptoms above named are sufficient to 
establish the diagnosis. The only disease with which it could 
be confounded would be intermittent or remittent fever, on 
account of its marked periodicity ; but under no circumstances 
need this be the case if we reflect that these diseases never 
present such aggravated symptoms. 



196 The Eclectic Practice of Medicine. 

Prognosis. — The prognosis is very unfavorable, though 
some few will recover; the duration of the disease is from 
four to twelve days, usually terminating fatally within the 
first week. 

Treatment. — To remove the exciting cause, prevent decom- 
position of the blood, and support the system, are the obvious 
indications. The first may be accomplished in some degree, by 
giving a free exit to purulent accumulations; and in this, 
as in cases of absorption from an open suppurating surface, 
the use of means to change the condition of the parts, destroy 
the elements of decomposition, and favor normal pus formation. 
For this absolute cleanliness is imperative, and the use of a 
lotion of Chlorinated Soda or solution of Sulphate of Zinc. 
If an external phlebitis exists, penciling the part with the 
Muriated Tincture of Iron is beneficial. 

No means are so important in preventing rapid changes in 
the blood, as those that check these violent disturbances 
of the circulation. For this purpose, ten grains of Quinia 
with an ounce of Brandy at the commencement of the 
intermission, and repeated if necessary, is the most efficient 
means. A solution of the Chlorate of Potash with Hydro- 
chlorate of Ammonia taken freely, with the internal ad- 
ministration of the Tincture of Muriate of Iron in doses of 
twenty or thirty drops every three or four hours will com- 
plete the treatment in many cases. If there is much pain 
so that the patient is rendered uneasy, and can not obtain 
rest, I should have no hesitation in giving full doses of 
Opium. 

Irritation of the stomach must be especially guarded 
against; if severe at first, and accompanied with retchings 
and vomiting, a thorough emetic is advisable ; if not so se- 
vere, it may be arrested by sinapisms to the epigastrium, and 
the use of an infusion of Peach bark. Animal broths and milk 
should be administered as freely as the stomach will bear 
them, and stimulants employed as may be necessary. The 
frequent use of the bath, alkaline to the trunk, stimulant to 
the extremities if there is coldness, is a very useful adjuvant 
to the treatment. 

If evidence of local determinations to internal organs 
should arise, dry cupping should be resorted to, and followed 
by stimulant applications; in some cases a blister would answer 
a good purpose. In addition, it is highly essential that 



Embolismus. 197 

normal circulation to the extremities and surface should be 
obtained if possible. If the joints are affected, they should be 
painted with the Tincture of Muriate of Iron, and poulticed 
with the decoction of Cornus and Wheat bran before named ; 
the same treatment is applicable to other external parts. 
When pus forms, it is good practice to give it exit by a free 
incision at the most depending portion, and promote free 
drainage. 



EMBOLISMUS. 

Obstruction of blood vessels by emboli, or clots or fibrinous 
vegetations, has been noticed and studied of late years. Ma- 
gendie, Cruvielheir and G-aspard have shown by experiment 
that foreign solid bodies floating in the blood, would obstruct 
the smaller blood vessels, and occasion inflammation and exu- 
dation. Virchou and others have reported cases in which coa- 
gula and fibrinous vegetations have been carried from the 
point where formed, as in the heart or varicose veins, to other 
and distant parts, causing an arrest of circulation and fatal 
disease. In some cases, the obstruction being of the larger 
and important blood vessels, death has occurred in a short 
time after the first symptoms or was immediate. Thus, M. 
Briquet reports a case in which the coagulum was carried 
from varicose veins of the leg (the saphena being inflamed) to 
the pulmonary artery. The symptoms were as follows : " After 
an excellent night she was seized by an undefinable sensation, 
and uttered a cry of alarm. She was found to be extremely 
pale, her features having undergone marked change. Her 
arms were convulsively moved, she complained of intense pain 
in the chest, and in a state of alarm declared she would be 
suffocated. The pulse was filiform, the heart beat tumultu- 
ously, but without abnormal sound, and she died at the end of 
twenty minutes." Post-mortem examination detected the ex- 
istence of large clots in the saphenous vein, and an obstruction 
in the pulmonary artery, extending from the valves to its arch, 
formed by a clot. 

Instances of the obstruction of the femoral, axillary and 
carotid arteries are named, in which sudden and alarming symp- 
toms were produced, and other cases in which obliteration of 
the vessel occurred, the patient living for some time. It is 



198 The Eclectic Practice of Medicine. 

supposed by Virchou that obstruction of the smaller vessels of 
the brain by fibrinous vegetations from the heart will account 
for many cases of sudden death from disease of this organ ; 
and also for cases of gangrene without any appreciable cause. 
The symptoms are of course variable, and the only evidence of 
emboli that we have, probably, is the absence of pulsation 
below the obstruction. I have noticed embolismus here, not 
for the purpose of giving a treatment, which can not be done, 
but for placing the facts above noticed as a guide to diagnosis 
in certain obscure cases. 



SCROFULA. 

Scrofula or king's evil is one of the most common diseases 
the physician has to treat; and manifesting itself in so 
many different forms, its symptoms are protean, and its treat- 
ment varied and difficult. It is undoubtedly a disease of the 
blood, though the secretions and nervous system are markedly 
affected. Copland remarks that " The blood in scrofula and 
tubercles has been long considered popularly, and with much 
truth, to be of a poorer quality than in healthy constitutions." 
Simon, states that the blood is deficient in solid constituents, 
especially in fibrin and in corpuscles. According to Dubois, 
the blood of scrofulous subjects coagulates slowly, the clot is 
small, soft, and diffluent; the serum is thin, and often of a 
reddish color. Under the microscope, some of the corpuscles 
appear devoid of color at the edges only, some entirely color- 
less. Their size is not materially changed, but they appear 
flattened, spherical, or cylindrical. Hence he infers that there 
is a deficiency of the salts in the blood of scrofulous persons. 
Mr. Phillips remarks that, in every casein which he examined 
the blood of scrofulous subjects, the coagulum was relatively 
small, the serum large, the clot unusually soft, almost diffluent ; 
in a few instances only, it was tolerably firm. In most cases 
the proportion of globules was considerably under the healthy 
standard. The fibrin had not generally undergone much 
change. The causes of scrofula, whether those acting on the 
parent, or the individual himself at a very early age, or even 
at later periods, whether external or internal, whether heredi- 
tary, congenital, or acquired, have all a similar tendency, 
namely, directly to depress, or to exhaust organic nervous, or 



Scrofula. 199 

vital power ; and thereby to impair vital resistance, to prevent 
the processes of repair consequent upon morbid vascular 
action, and to arrest the formative or organizing tendency of 
the exudations produced by this action. Not only is there a 
disposition to a dyscrasia — to a solution of vital cohesion, ob- 
servable in parts near the seat of serofulosis, but there is also 
an absence of the formative effort in the fluids exuded by mor- 
bid actions in scrofulous constitutions. The state of vital 
power or endowment in the several tissues or organs of scro- 
fulous persons, appears insufficient both for the healthy or 
sthenic actions or functions these parts should perform, and 
for the organization of the fluids or matters effused from their 
vessels. Hence the changes which the exuded matters undergo 
neither favor nor are followed by organization, even in its low- 
est grades: and most probably, the fluid itself is exuded from 
the capillaries of a kind and in a state which indisposes it to 
organization. 

Scrofula is said to be hereditary, and so it is in this, that the 
child inherits a defective vitality, which manifests itself in 
imperfect elaboration of the blood, and enfeebled vitality of tis- 
sues and organs. Such persons may live for years without any 
manifestation of the disease, simply because there has been no 
cause acting to further depress vitality, or determine scro- 
fulous deposit. Finally, however, from arrest of secretion or 
other cause, the system is depressed, and an irritation of some 
part being set up at the same time, we have full manifestation 
of the disease. 

If we have correctly stated the pathology of the disease, 
what measures may be adopted to remove this predisposition? 
Some contend that it can not be removed, but we have evi- 
dence sufficient to show that it can be entirely eradicated. To 
accomplish this we resort principally to hygienic measures, such 
as will stimulate healthy digestion, secretion, and innervation. 
Remove the child to the country, let it have plenty of out-door 
exercise with accompanying light and sunshine, give it nutri- 
tious food and eschew condiments, pastry, and sweet-meats, 
and the entire constitution of the child will undergo a change. 

Scrofula manifests itself in various ways; very frequently 
the deposit commences in the lymphatic glands; sometimes 
in the viscera, as of the lungs, liver, brain, etc.; again in the 
bones, in the muscles, in the skin, in fact in all the tissues of 



200 The Eclectic Practice of Medicine. 

the body. The determining cause of the deposit is undoubt- 
edly an irritation of the part causing determination of blood. 

Symptoms. — The symptoms of a scrofulous constitution are 
not well-marked, though it has been frequently described 
as if it were. It is true that it occurs most frequently in chil- 
dren of fair skin, blue eyes, light hair, and regular features ; 
but it is so often met with in persons of dark skin, hair and 
eyes, irregular features, and rough development, that it is 
impossible to say by a child's appearance whether it is scrofu- 
lous or not. There is, however, in very many cases, such 
manifest imperfections in assimilation, circulation, and nutri- 
tion, and feeble vitality, that we are enabled to recognize the 
scrofulous constitution. Usually, the previous history of the 
family will throw some light on the matter ; but, as Prof. 
Powell has well demonstrated, the scrofulous constitution may 
be and is often developed in children by incompatibilty of the 
parents. 

Scrofula manifests itself when, from any cause, the vitality 
of the system is so depressed that the blood is not properly 
elaborated, or the detritus of the system is not removed, either 
by an imperfection in the process of retrograde metamorphosis, 
or by failure of the excretory organs. The situation is deter- 
mined in all cases by the existence of a local irritation or 
inflammation in or adjacent to the parts affected. Thus, we 
observe scrofulous deposit, and disease of the cervical lym- 
phatic glands, from disease or irritation of the mouth or 
throat; involvement of the axillary glands, from disease of the 
arm or breast; of the inguinal glands, from disease of the lower 
extremity, or genital organs ; of the mesenteric glands, from 
disease of the bowels ; of the lungs, from irritation produced 
by cold ; and in the muscles and bones from the same causes. 
It might be divided into two forms, as it occurs in the lym- 
phatic glands, or as a deposit in the form of tubercles in the 
structure of a part, but no practical benefit would grow out of 
such distinction. As we have in other places described scrofu- 
lous or tubercular affections of the principal organs, we will 
confine ourselves here to a description of it as it affects the 
lymphatic glands. 

In many cases the irritation giving rise to the development 
of scrofula is very manifest, and occasionally demands treat- 
ment, but in others it is very slight. The superficial lym- 
phatic glands are then observed to become slightly enlarged 



Scrofula. 201 

and hard, so as to be very perceptible when the finger is 
passed over them. This occurs frequently in scrofulous chil- 
dren in the superficial cervical glands, without further develop- 
ment, and is considered by many as the best indication of a 
scrofulous constitution. When the disease is fully commenced, 
one or more of the glands continue to enlarge, a low form of 
inflammation sets in, and deposit takes place in the adjacent 
tissues, which become swollen and hard. £fow the inflam- 
mation becomes more or less acute, the part is reddened, pain- 
ful, hot, tender on pressure, and the swelling increases rapidly. 
Continuing in this way for a longer or shorter time, suppura- 
tion commences, and the deposit is gradually changed into 
pus, which in time makes its way to the surface, and is dis- 
charged. This occupies a variable period of time, sometimes 
passing through all its stages in eight or ten days, and at 
others occupies as many weeks. In some cases the inflam- 
mation is acute and the pain severe, but in others it progresses 
without much redness, heat, or pain. 

The pus forms slowly in many cases, and there is but little 
tendency to its discharge, and in others weeks pass over, the 
part still continuing hard ; and at last, when our patience is 
nearly exhausted, suppuration occurs rapidly. Sometimes the 
pus is well formed and healthy, and when discharged, the part 
heals readily ; but at others it is watery, of a greenish-brown 
color, or clear, with more or less flocculent material mixed 
with it. Occasionally the abscess exhibits no tendency to 
point, but the -pus burrows in the tissues for a long time, 
unless it is opened. In other cases, when the pus is discharged 
the abscess does not heal, but continues to discharge a dirty, 
flocculent pus ; and if we examine it, we will find the walls 
ragged, and often a chain of lymphatic glands dissected out? 
and lying at the bottom. 

The constitutional disturbance varies greatly. Sometimes 
there is quite brisk febrile action when inflammation first 
comes up, with loss of appetite, arrest of secretion, and much 
prostration. In these cases, suppuration is frequently marked 
with a chill or rigor, and occasionally attended with hectic 
fever and night sweats. In other cases, there is no constitu- 
tional disturbance further than loss of strength, and some 
derangement of secretion, languor, and a peculiar pallid 
appearance of the surface. 

Diagnosis. — Scrofulous enlargement is readily recognized 



202 The Eclectic Practice of Medicine. 

from its situation, and from the attendant symptoms above 
named. 

Prognosis. — In very many cases the prognosis will be favor- 
able, as the tendency to the disease is not so strong, but that 
it may be removed by appropriate treatment, and measures 
calculated to improve the general health. There is no doubt 
but that by proper care the constitution of a child can be so 
entirely changed, in the course of time, that the tendency to 
this disease will be entirely removed. There are other cases, 
however, in which, though we may get the patient safely 
through the present attack, they will inevitably die, sooner or 
later, of this or some analogous affection. 

Treatment. — When children are predisposed to scrofula, a 
judicious hygienic plan should be adopted to strengthen the 
constitution, by improving the functions of digestion, assimi- 
lation and nutrition. Such children are said to be tender, and 
hence they are kept in the house a considerable part of the 
time for fear of colds and sickness, and being weakly they 
are petted, and their appetites pampered; and not spending 
their time in play, as they should do, their minds are preco- 
ciously developed at the expense of their bodies. Instead of 
this, such children should be accustomed to the open air from 
an early age. As with plants, the human species can not be 
robust and stout without fresh air and sunshine. As soon as 
they commence walking they should play in the open air 
whenever the weather is suitable. In this way, the constitu- 
tion is strengthened, and the liability to colds by alternations 
of temperature much reduced. Sleeping-rooms should in all 
cases be large, well-ventilated, and exposed to the direct rays 
of the sun during some portions of the day. Up to the age 
of eight or ten years, the child's occupation should be out of 
doors, and whether it was play or work, it should be of such 
a character as to bring into action all the muscles of the body. 
Before this age the child should not be required to study, 
neither should it be sent to school, there being sufficient time 
after this for all laudable educational purposes. Regular 
meals of good, hearty food, with fruits in their season, with a 
sedulous avoidance of all cakes, sweetmeats, etc., are of the 
highest importance. An observance of these rules, the children 
being raised in the country, will almost invariably result in 
a complete change of constitution, and such increased vitality 
that not only is the predisposition to this disease removed, but 



Scrofula. 203 

the child becomes a vigorous, hearty man or woman, instead 
of dropping into a premature grave from phthisis or some 
kindred affection. 

In the treatment of the disease, the indications are to, 1st, 
improve the quality of the blood and raise it above the point 
at which scrofulous material is effused, and, 2d, to promote the 
absorption and elimination of such material as may have been 
deposited. To accomplish these indications various means are 
resorted to, according to the condition of the patient. Altera- 
tives are relied upon to a very great extent, and various 
agents of this class are employed. By some the Compound 
Syrup of Stillingia and Iodide of Potassium are considered the 
preferable agents, and are used to a very great extent. My 
experience has not been favorable to these remedies, and I have 
been compelled to select others. I now use the Eumex Crispus, 
Alnus Serrulata, Scrophularia, Podophyllum, Corydalis, and 
some two or three other agents, sometimes singly, or two or 
three combined to suit the indications of the case. Ace- 
tate of Potassa is my main dependence to promote absorption 
and elimination by the kidneys. I believe it to be as much 
more efficient than Iodide of Potassium, as this is over 
Epsom Salts; at the same time employing the bitter tonics, 
Iron, the Hypophosphites, and Cod -liver Oil. 

Very much depends upon getting proper action of the three 
principal emunctories — the skin, kidneys and bowels. Great 
care is necessary, however, in the severer cases, not to over- 
stimulate and exhaust these organs. To restore the secretion 
of the skin, I employ — if it is dry and husky — oleaginous 
frictions, followed by thorough washing with Castile soap and 
water; if soft, relaxed and flabby, I use the bitter tonic 
baths ; if there is deficient capillary circulation, with coldness 
of the extremities, a sponge-bath of dilute Tincture of Capsicum. 

As a local application to promote resolution, I have used 
equal parts of Tinctures of Belladonna and Stramonium, and 
Glycerine, or if there is much fever, an equal part of Tincture 
of Aconite. In other cases, a wash of equal parts of Tincture 
of Muriate of Iron and Glycerine may be used, or the part may 
be painted with the Iron, and then followed by the lotion 
named. In some cases we obtain good results from the use of 
the Mayer's Ointment or the black salve ; finely pulver- 
ized Indian Turnip, made into a poultice, is an excellent appli- 
cation. If there is much heat and redness, we may use 



204 The Eclectic Practice of Medicine. 

fomentations of Stramonium leaves, or a poultice of a de- 
coction of Cornus and Wheat-bran. If it is seen that resolu- 
tion can not be effected, we will employ poultices to facilitate 
suppuration, and if pus has formed to any extent, instead of 
permitting it to burrow, we will immediately open the ab- 
scess. The poultice may be continued for a few days longer, 
until the inflammation has passed off, when it may be dressed 
with Mayer's Ointment, or other stimulant application, until it 
heals. If it does not discharge well, and looks ragged, it will 
be best to use a solution of Sesquicarbonate of Potassa until 
suppuration becomes free. And in those cases in which the 
healing process is slow and the discharge thin and watery, it 
may also be employed with advantage. 

In some cases the healing process progresses until the ab- 
scess is nearly closed, but a red, ugly cicatrix is left, from which 
there is more or less oozing ; or if it closes, it breaks out 
frequently, and after running for a few days again closes, with 
a thin, bluish cicatrix. These cases are remarkably tedious, 
and are very difficult to cure. I have treated them by em- 
ploying the Zinc paste to entirely destroy the morbid cicatrix, 
and then healing with some mild, stimulating ointment ; or, 
instead of this, we may sometimes dissect the cicatrix out, and 
draw the parts together with adhesive straps. In other cases, 
we will find that a decoction of equal parts of Cornus, Eumex 
and Alnus, continually applied, and taken internally, will in 
time overcome the disease. 



DEOPSY. 

It is very difficult to decide under what head dropsy should 
be placed ; but as it is now generally conceded that in many, 
if not a majority of cases, it is dependent upon some lesion of 
the blood, it may properly come in at the close of this chapter. 
We have already noticed some forms of local dropsy in other 
parts of this work, and we will here confine ourselves to a 
general description of the disease. 

Dropsy may be first divided into idiopathic and symptomatic* 
as it arises from disease of the blood, or from some local dis- 
ease or change of function. In the first case it is either active 
or passive ; i. e., active, as caused by active congestion, deter- 
mination of blood, or inflammation, as is witnessed in hydro- 
thorax, from disease of the pleura, ascites from disease of the 
peritoneum, and of the cellular tissue as the result of erup- 



Dropsy. 205 

tive fevers ; or passive as the result of debility, impoverished 
condition of the blood, feeble circulation, and relaxation of 
the tissues. Symptomatic dropsy results from lesion of some 
part or organ, which interferes with the free circulation of the 
blood, as is seen in heart disease, granular disease of the 
kidneys, and some affections of the liver. 

Symptoms. — Active and sthenic dropsy usually occurs as a 
sequel of fevers or inflammations, or comes up during their 
progress. It is of frequent occurrence after scarlatina, and 
some affections of the viscera, and as dropsy of the serous 
cavities is associated with determination or sub-acute inflam- 
mation of the serous membranes. It may result from sudden 
arrest of the secretions of the skin and kidneys, the dropsy 
making its appearance with great rapidity. In these cases we 
will find the skin dry and harsh, the urine scanty and frequent- 
ly acrid and scalding, the bowels constipated, the tongue 
coated, appetite gone, headache, and a hard, resisting pulse, 
increased in frequency some ten or fifteen beats per minute. 
These symptoms sometimes continue until the dropsy is fully 
developed, and then disappear, but at others they continue in 
an intermittent form throughout the entire disease. The 
dropsical effusion may be in the cellular tissue, or in one or 
more of the serous cavities, or it may affect both. Its dura- 
tion is very variable, and it will sometimes pass off without 
assistance, though at others it is very stubborn. 

Passive or asthenic dropsy occurs as the result of local or 
general debility, and especially of some change in the condi- 
tion of the blood. Dr. Copland remarks, that " In its prima- 
ry form it may be attributed chiefly to relaxation of the 
exhaling pores, and of the serous and cellular tissues, and to 
increased tenuity or alterations of the blood, independently of 
any considerable structural change/ It is sometimes caused by 
excessive sanguineous evacuations, or exhausting discharges ; 
by the suppression of secretions, and by a deficient, watery, 
vegetable and unwholesome diet. The dropsy that sometimes 
prevails amongst the poor in times of scarcity is generally of 
this kind. It is usually characterized by a weak, unequal, 
small and frequent pulse, paleness of the lips, tongue and 
gums, flaccidity of the muscles, anhelation on slight exertion, 
feebleness of the joints, swellings of the lower limbs, or 
anasarca attending or preceding, or attending the effusion into 
the cavities of the trunk; an unhealthy appearance of the 



206 The Eclectic Practice of Medicine. 

cutaneous surface, and absence of those symptoms which indi- 
cate the existence of visceral obstruction or disorganization. " 

Dropsy from disease of the heart is usually preceded by such 
evident symptoms of disturbance of the circulation that it is 
difficult to mistake it. The patient has had a sense of weight 
and pain in the praecordia, with palpitation or sense of op- 
pression and faintness on taking active exercise, and other 
evidences of heart disease. It usually comes on slowly, mak- 
ing its appearance first as a puffiness of the face, hands and 
feet ; the first in the morning on rising, the second in the 
evening. The effusion occurs in the chest and abdomen most 
frequently and only occasionally as an anasarca. With the 
appearance of the dropsical effusion we find that the patient 
loses strength rapidly, the symptoms of disease of the heart 
increase, there is a feeling of weight in the prsecordia, and it 
is impossible for the patient to sleep unless the head and 
shoulders are well raised ; and in some cases it is impossible 
for them to lay in bed, either night or day. 

Dropsy not unfrequently has its origin in disease of the 
liver, stomach and spleen, though we can not see any connection 
other than the effect that long-continued disease of these 
organs would have upon the blood. The dropsy that follows 
severe and protracted intermittent fever is almost invariably 
associated with disease of the spleen and liver, and proper 
treatment directed to those organs is indispensable to success. 
Among the most inveterate cases of dropsy are those that are 
associated with long-continued dyspepsia. In some cases, the 
ascites seems to result from obstruction to the passage of the 
portal blood through the liver, and is removed by measures 
that will stimulate this viscus to action, and thus permit free 
circulation. 

"We have, in another place, noticed that albuminuria or 
Bright's disease of the kidneys, almost invariably produced 
dropsy by depriving the blood of a portion of its albumen, and 
thus destroying its plasticity and power to pass freely through 
the capillaries. Some writers contend that the kidneys are 
thus in fault in all cases of dropsy though the disease spoken 
of may not exist. If this were so, however, we would always 
find albumen in the urine on examination, whilst we know 
that in very many cases, it is absent before or during the 
progress of the disease. 

Dropsical effusion occurs in the cellular tissue, taking the 



Dropsy. 207 

name of anasarca; in the cavity of the peritoneum, ascites; 
in the pleural cavity, hydro-thorax; in the pericardium, 
hydro-pericardium ; in the cavity of the arachnoid, hydro- 
cephalus ; in the tunica- vaginalis, hydrocele ; and in the syno- 
vial membranes, hydrarthrosis. 

In anasarca, the effusion is in the delicate net work of the 
cellular tissue, and at first confined to the superficial fascia, 
though as the disease progresses, it affects the deep-seated 
areolar tissue as well. In chronic or passive dropsy it appears 
first in the feet, usually in the form of oedema, and gradually 
extends upward to the body. In acute or active dropsy, it 
frequently manifests itself first in swelling of the eyelids, face 
and upper parts of the body. Frequently the lower half of 
the body is the principal seat of the disease, the upper ex- 
tremities, face and trunk, being but slightly affected. The 
amount of effusion varies greatly, sometimes being compara- 
tively slight, the parts being swollen and pitting on pressure, 
and at others being distended until the skin seems smooth and 
glistening and ready to burst. The parts are usually cool and 
to some extent numb, there being a feeble circulation of 
blood in them and occasionally the distension becomes so great 
that the skin is ruptured or ulcerated and the fluid oozes out. 

Ascites or dropsy of the abdomen, occurs more frequently 
than any other form but anasarca. The symptoms are the 
same as are common to dropsy in general, with the addition 
of the feelings of unpleasant weight and distension of the 
abdomen. The diagnosis is usually not difficult, the regu- 
larity of the enlargement, dullness on percussion over the 
most dependent portion, and resonance over the superior part, 
with the distinct succussion on palpation are prominent signs. 

As heretofore noticed, hydro-thorax is attended with difficult 
and oppressed respiration, proportionate to the extent of the 
effusion. There is marked dullness on percussion over the 
most dependent part of the chest, which is changed by change 
in the patient's position; that peculiar sound termed sego- 
phony is developed; the intercostal depressions are effaced; 
and we frequently have the evidence of succussion. 

Hydro-pericardium is with difficulty distinguished from 
hydro-thorax, though when connected with this the situations 
of the dullness, and its confinement to one spot, though the 
position of the body be changed, is the best evidence. It is 
usually connected with disturbance of the action of the heart, 



208 The Eclectic Practice of Medicine. 

and the patient can not in many cases remain in the recumbent 
position for any length of time. 

Diagnosis. — The diagnosis of anasarca is usually easy, as 
the enlargement is marked, and physical examination shows 
it to result from accumulations of water. The diagnosis of 
dropsy of the cavities is more difficult, but attention to the 
points above mentioned, and those laid down in the descrip- 
tion of the diseases of the organs named will suffice for their 
distinction. 

Prognosis.— In active dropsy the prognosis is usualty favor- 
able, except in dropsy of the pericardium which is always 
unfavorable. In asthenic dropsy, our prognosis will depend 
to a very great extent upon the causes of the attack, and the 
general health of the patient. "Where dropsy is symptomatic, 
it will of course depend upon the character of the disease 
producing it: thus dropsy from disease of the heart, or B right's 
disease of the kidney will be looked upon unfavorably ; but 
if from temporary change of function of the kidney, liver, 
spleen, etc., we would expect a speedy cure. 

Treatment. — In active dropsy I commence the treatment 
by the use of the special sedatives, as #, Tincture of Aconite, 
Tincture of Veratrum, aa, f3ss; Essl. Tincture of Asclepias, 
f3j; Aqua, fSiij; M.; and give in doses of a teaspoonful 
every hour until the skin becomes slightly moist, and then 
every two or three hours, as circumstances may require. To 
assist this, I direct the use of the alkaline bath and hot foot 
bath, or, if it can be given, the general warm bath, or in se- 
vere cases the vapor bath. If there is considerable derange- 
ment of the stomach, as is sometimes the case, it will be well 
to give a thorough emetic, of the Compound Powder of Lo- 
belia in infusion. If there is much irritability of the nerv- 
ous system, we would associate with the remedies first named, 
the Macro tys and Gelseminum. As soon as the system has 
been brought under the influence of the remedies named, 
Quinia and Hydrastine should be given to the extent of four 
to six grains of each daily. This treatment is preparatory to 
means for the removal of the dropsical deposit, and though it 
may not be necessary in all cases, it is essential in very many. 

Very generally we will find that secretion becomes better 
under the use of the above treatment, and if the dropsical 
deposit is not lessened, it has not increased. I do not deem it 
desirable in many cases to give a cathartic or diuretic until 



Dropsy. 209 

the hardness of the pulse and constriction of the skin has been 
removed, which usually occupies from one to three days. Now, 
we administer a hydragogue cathartic, and I know of none 
better for general use than the Compound Powder of Jalap 
and Senna, and Bitartrate of Potassa, in equal parts, giving 
one drachm every three or four hours, daily, until copious 
watery evacuations are produced. Instead of this, we may 
give Jalap, grs. xv; Bitartrate of Potassa, 3ss to 3j for a dose; 
or, Elaterium, grs. ij; Bitartrate of Potassa, 3iv; triturate 
thoroughly and divide into eight powders, one of which may 
be given every three or four hours until it acts briskly. The 
cathartic may be administered every day to the extent of pro- 
ducing two, three or four watery evacuations daily, unless it 
gives rise to irritation of the bowels or exhaustion. As soon 
as the bowels have been freely moved, and not before, we 
commence with diuretics to increase the evacuation of water 
by the kidneys. A very good eliminative, though not a pleas- 
ant one, is #, Acetate of Potassa, 3ss; Spts. ^Etheris Nltrici, 
Tincture of Juniper, aa, f3j; Aqua, f^ii; M., and give a tea- 
spoonful every two or three hours; or I sometimes employ an 
infusion of Hair-cap Moss or Eupatorium Purpureum. If 
there seems to be necessity for a stimulant, I know of nothing 
so good as the Gin Bitters taken freely. 

In asthenic dropsy the treatment will have to be both evacu- 
ant and sustaining. If the tongue is coated, the breath bad, 
with failure of the appetite and imperfect digestion, I would 
strongly recommend that the treatment be commenced with 
an emetic, if there is nothing to contra-indicate it. An 
emetic sometimes so changes the action of the system, 
that remedies which previously had no influence now act 
well. Following this, we would put Hhe patient on the 
use of the bitter tonics and Quinia, and as much stimulus 
as seems necessary to keep the strength up. Equal parts of 
Quinia and Hydrastine, or Essl. Tinctures of Collinsonia, Cor- 
nus, and Ptelea, with as much of the Gin Bitters as seems 
to agree with the patient, should be continuously given, and 
they may be changed for others, as occasion requires. They 
should be so employed, if possible, that the patient shall gain 
rather than lose strength during the treatment. Associated 
with these means, we would use tonic and stimulant baths to 
favor free circulation of blood to the surface, and especially to 
prevent congestion of internal organs. Now, we may employ 
14 



210 The Eclectic Practice of Medicine. 

the hydragogue cathartics and diuretics to remove the water 
from the system, expecting that, as we thus deplete the blood- 
vessels, they will supply themselves from the dropsical effu- 
sion. Of course the patient must not be permitted to take as 
much fluid as is evacuated, for if so, our treatment will of 
course be unsuccessful. The formulas for cathartics and diu- 
retics might be indefinitely increased, but as heretofore re- 
marked, a few good remedies are better than a large number 
of poor ones. A reference to the appendix of the Materia 
Medica will furnish a variety of good combinations. 

In dropsy from heart disease we would pursue the above plan 
of treatment, with the additional remedies demanded by the 
local disease. Dropsy from albuminuria has been already de- 
scribed, but its treatment does not materially differ from other 
forms, further than the limited use of diuretics, and the means 
demanded for the disease of the kidneys. Dropsy from dis- 
ease of the spleen or liver, following intermittent fever, should 
be treated as named for protracted intermittent, with the ad- 
dition of the hydragogue cathartics and diuretics. In ascites 
from disease of the liver, we will endeavor to promote its ac- 
tion, and facilitate the circulation of the blood through it. 
We occasionally find a case in which, from irritation of the 
bowels and kidneys, we can not use the common means recom- 
mended. In these cases I have obtained much advantage from 
the employment of Tannic Acid in doses of twenty grains four 
or five times a day, associated with such means as seem to be 
indicated by the condition of the system. 

As regards the propriety of operative interference, there has 
heeu mueh dispute, some contending for it, others against it. 
In persistent cases of anasarca, I am satisfied that incisions 
into the cellular tissue, and followed by moderate compression 
with the roller, is sometimes attended with the best results. 
In ascites, tapping is frequently performed, but unless associ- 
ated with proper treatment to restore tone to the exhalents, 
and to induce free secretion, it is only a temporary palliation. 
Tapping is rarely resorted to in hydrothorax, and only in cases 
in which the effusion is the result of inflammation of the 
.pleurae. 



Derangements of Dentition. 211 



CHAPTER IY. 

DISEASES OF THE DIGESTIVE APPARATUS. 

This important class of diseases should be thoroughly- 
studied, as some derangement of the digestive apparatus is 
met with in almost all forms of disease. To obtain a clear 
idea of the nature of these affections it is necessary to have a 
distinct knowledge of the organs which are the seat of them, 
and of the functions they perform. No animal function dis- 
plays a greater diversity of means for its performance than 
that of digestion, and none plays a more important part in the 
economy, or has more extended sympathies ; being the center 
from which all parts originally derive the material for nu- 
trition, we can well understand why any change of function 
in these parts, if it continues, will eventuate in disease. The 
close sympathy existing between this and other portions of 
the body accounts for the general derangement that follows 
disease here, and the almost invariable functional derange- 
ment of this apparatus that exists during other diseases. 



DERANGEMENTS OF DENTITION. 

Dentition or teething is a physiological process, and not a 
disease, as many imagine. If the body is in a normal condi- 
tion, and not warped to too great an extent by customs called 
civilized, then the process of cutting the deciduous teeth is 
painless and without unpleasant consequences. But if the 
converse, then the eruption of the teeth may be the source of 
irritation which will cause disease of various parts. We can 
readily see how this may be if we examine other parts : for 
instance, the function of sight is performed with pleasure and 
advantage to the eye, if in a healthy condition; but if 
diseased, it is sometimes the source of great irritation. 

Irritation. — Occasionally we find that the gums become 
very tender, or the child is continually working with its 



212 The Eclectic Practice of Medicine. 

mouth, and desiring to bite something; it is irritable and fret- 
ful ; there is some fever, increased heat of head, or sometimes 
pallor and dilatation of the pupils. It is true, that many times 
these symptoms will pass off without danger to the child; but 
often they do not, giving rise to a low form of fever, disease 
of the brain and convulsions, or derangement of the bowels. 

The treatment of this condition is comprised in a mild seda- 
tive as Tincture of Aconite gtt. xx, to Aqua 3iv, in doses of a 
teaspoonful every hour or two; and if the child is nervous, and 
exhibits evidences of convulsion, the addition of Tincture of 
Gelseminum 3j to 3ij, for a child one year old. If the bowels 
are constipated; a dose of Castor Oil, or Compound Powder of 
Jalap and Senna in infusion is indicated, and the general bath 
and hot foot-bath should not be neglected. If there is diar- 
rhoea, it should not be suddenly checked, but the Neutralizing 
Cordial, or Compound Powder of Rhubarb in infusion, admin- 
istered until it produces one operation, and afterwards in 
smaller doses; or the infusion of Epilobium may be used. 

Congestion. — The irritation occasionally causes determina- 
tion of blood, and the gums become swollen and tender to the 
touch; there is fever, marked irritation of the nervous system, 
with occasional convulsions. In this case, if the gums are 
purplish, cutting down to the teeth, though it will not cause 
them to appear any sooner, will, by relieving the tension of 
the gums, remove the irritation and fever very speedily. 

If the gums are red and swollen, it is of no advantage to 
lance them, unless the tooth is so near the surface that it will 
be exposed by the retraction of the gum. In all other cases 
but these the use of the lancet should not be tolerated. 

In these cases it is beneficial to open the bowels, and admin- 
ister the remedies named above. Sometimes the little patient 
is extremely restless and troublesome, its sleep being troubled 
and broken ; in this case I have employed #, Tincture of Lav- 
ender Comp. 3iij; Tincture of Lobelia 3j; Simple Syrup 3jss; 
in doses of half a teaspoonful as often as required: or Oil of 
Anise 3ss ; Opium, grs. ij ; prepared Chalk and white Sugar, 
equal parts, 3ss; triturate thoroughly, and administer in doses 
of two or three grains as often as necessary. 

In all of these cases, the child's diet should be light and 
unirritating; it should be taken in the open air, kept in good 
humor, and not disturbed during sleep on any account. 
Erom the third to the sixth year the teeth frequently decay, 



Odontalgia. 213 

giving rise to vitiated secretions, bad breath, and disordered 
stomach. 

The evil results are sometimes so serious that there is no 
means of reaching them except by removal of the entire 
decayed teeth. It would surprise a person who had never 
witnessed it to see what a speedy restoration of health will 
thus follow; the irritation is removed, the bad breath gone, the 
stomach regains tone, and the child, heretofore weak and 
puny, becomes healthy and strong. 



ODONTALGIA. 

Toothache is considered a minor matter by those studying 
medicine, but not by those suffering the pain ; and every one 
who practices medicine should understand how to treat it skill- 
fully. It may be divided into three forms : irritation of the 
exposed nerve, inflammation of the dental pulp, and inflam- 
mation of the periosteum, investing the alveolus and fang of 
the tooth. 

The first may be recognized by the intermittent character 
of the pain, the intermission being so perfect frequently that 
there is no evidence of disease remaining. 

Inflammation of the pulp may be recognized by the contin- 
uous character of the pain, the soreness of the carious portion 
of the teeth, and some constitutional disturbance. If it is not 
arrested, it goes on to suppuration, inflammation extend- 
ing through the dental canals, affects the apex of the fang, 
pus forms at that point, and necessitates the removal of the 
tooth. Dentists not unfrequently meet with this after filling 
a tooth. 

The third variety is periostitis, and is recognized by the 
feeling of tension, the tooth seeming to be elevated above its 
fellows, tender to the touch, and a continuous dull aching 
feeling, as if the tooth was some foreign body. 

Treatment. — The first form may sometimes be relieved by 
local applications, as the Tincture of Aconite, Morphia thor- 
oughly triturated with an equal part of Alum ; Tincture of 
Opium and of Gelseminum; or, the applications of the Essential 
Oils or of Creosote. The last is employed with advantage 
for some days to remove the soreness, before getting the tooth 
rilled. Counter-irritation behind the ears, or to the back of the 



214 The Eclectic Practice of Medicine. 

neck, the hot foot bath and a mild cathartic are appropriate 
means. If distinctly periodical, it may be arrested sometimes 
by the use of Quinia, as for any other intermittent. 

The other two cases are cases of inflammation and should 
be treated like all other affections of this class, to promote 
resolution and preserve the organ. For this purpose, a brisk 
cathartic followed by an alkaline diuretic, and opiate, is about 
the best treatment ; counter-irritation by the hot foot bath, 
cups or blister behind or before the ear, or to the nape of the 
neck, is useful, as are also, hot fomentations to the face. As 
a local application when the pulp is affected, the Tincture of 
Aconite, or Creosote with Morphia, are the best applications. 
If of the periosteum, the gum may be penciled with Tincture 
of Aconite or Belladonna. If pus forms in the alveolus, it is 
possible sometimes to save the tooth by making a free incision 
down to the collection with a long gum lancet. This treat- 
ment should only be adopted in cases where the tooth is likely 
to be of service after proper filling, and should not be adopted 
in other cases, as extraction is the quickest and true course 
when the tooth can not be filled. If the toothache is stopped 
by the means above named, no time should be lost in consult- 
ing a good dentist and having the proper work done. 



STOMATITIS. 

Inflammation of the mouth manifests itself in many differ- 
ent forms, and may be either a primary or secondary affection. 
Many forms are very troublesome to the patient and being 
connected with some other affection, or a general cachexia, are 
difficult to remove. 

Simple stomatitis is characterized by heat, dryness, slight 
swelling of a part or the whole of the mucous membrane, 
and an erythematous redness of the part inflamed. It is not 
an unfrequent complication of diseases of the intestinal appa- 
ratus, and the eruptive and other fevers. Becoming sub-acute 
the tenderness disappears to some extent, but there is increased 
activity of the mucous follicles, and the secretion of a ropy 
mucus. 

In treating this affection it is necessary that any irritation 
of the stomach be removed, and the bowels kept soluble ; this 
may be accomplished by the administration of an infusion of 



Stomatitis. 215 

the Compound Powder of Rhubarb and Potassa. Then th e 
use of any simple astringent wash will relieve the local disease ; 
as, make a strong infusion of sage or privet, sweeten with 
honey, and to half a teacupful add 3i of pulverized Borax; an 
infusion of Hydrastis or Coptis, is excellent, as is also a solu- 
tion of Chlorate of Potassa, with a small portion of Glycerine. 

Chronic stomatitis may be the result ot the simple form 
just named, when it is chiefly confined to the gums, and often 
kept up by carious teeth. In some cases the gums become 
spongy and red, and sometimes so tumified as to look like 
fungous growths ; in others the gums ulcerate and are finally 
destroyed, the alveolar processes are absorbed and the teeth are 
loosened and fall out, or, have to be extracted on account of 
their tenderness. 

A more malignant form of chronic stomatitis, often lasting 
for years is met witji ; almost the entire mouth and tongue is 
affected, the mucous membrane is of a dusky purple color, 
looks somewhat honey-combed from previous ulceration, yel- 
lowish vesicles spring upward and soon discharge, giving 
rise to a small ulcer, some of which are constantly present ; 
the mouth feels hot, is exquisitely tender, sometimes bleeds 
easily, the gums and teeth are 6ore, and the patient can not 
eat solid food except with great pain. Various derangements 
of the system exist with this form of stomatitis, and require 
careful diagnosis. 

The treatment of the first form of stomatitis named, is usually 
not diflicult. Carious teeth and old fangs should be removed 
at the commencement, and a wash of Myrrh and Hydrastis, 
or, equal parts of Myrrh, Orris and Charcoal used freely. If 
this does not seem sufficient, a strong decoction of equal parts 
of Alnus, Rumex and Quercus Rubra may be employed, 
alternated with a solution of Chlorate of Potassa. 

In the last form, I usually direct equal parts of the Tincture 
of Muriate of Iron and Glycerine, sometimes penciling the 
parts with the first named, if very soft and spongy ; this may 
be followed by the use of a decoction of Cornus and Rumex, 
the washes first named may also be used. The internal treat- 
ment in these cases is very important, the Compound Syrup of 
Stillingia in doses of a teaspoonful with five grains of Chlorate 
of Potassa, may be given every four honrs, or, the Compound 
Tincture of Corydalis, may be substituted for the Stillingia in 
the same doses. The Chlorate of Potassa answers an admirable 



210 The Eclectic Practice of Medicine. 

purpose and should not be neglected. If there is irritability 
of the stomach with irregularity of the bowels, it is well to 
give the Compound Syrup of Rhubarb and Potassa, and follow 
with a gentle tonic, as Collinsonia or Hydrastis. 

Pseudo-Membranous Stomatitis. — Under this head Copland 
describes a form of sore mouth, which appears in the shape 
of small irregular patches of a greyish white color, the parts 
surrounding being red, painful and hot. "The breath is foetid, 
and the submaxillary glands enlarge. As the disease proceeds* 
the patches of membranous exudation extend, become more 
or less detached, and are succeeded by others, and the inter- 
vening surfaces are red and swollen. The tongue is swollen 
and the mouth continually open, allowing the escape of altered 
saliva. The enlargement of the lymphatic glands increase, 
the face swells, the breath becomes more foetid and the pulse 
more quick and rapid, and generally soft, open, or full and 
weak." The disease sometimes extends back to the throat, 
and even involves the mucous membranes further, sometimes 
occasioning imminent danger. It may become chronic and con- 
tinue weeks or months. 

Treatment. — At the commencement, relieve irritation of the 
stomach, either by the administration of an emetic, or if 
thought best, by milder means. A tonic, sustaining course of 
treatment is then necessary, as the administration of Quinia 
and Ilydrastine, with some preparation of Iron, and frequent- 
ly one of the mineral acids. These means should be varied, 
and continued constantly, and in addition Chlorate of Potash 
will be found useful. 

As a local application, the Hydrochloric Acid with Honey, 
one part to three, four or six, will be found as good as any 
thing; it should be applied with a small piece of sponge 
attached to a stick, to the membranous exudations, being care- 
ful to reach them all. At the same time, a saturated solution 
of Chlorate of Potash, with a small portion of Glycerine, may 
be frequently used. An infusion of Cinchona, acidulated with 
Hydrochloric Acid, has been recommended subsequently, but 
I would prefer the decoction of Eumex, Alnus and Quercus 
Rubra. 



Apthje — Ulcerative Stomatitis. 217 

APTII^E. 

We may include under this head thrush and follicular in- 
flammation. It makes its appearance in the form of small 
white points or patches on a red and inflamed base. The 
mouth is tender and irritable, so much so, that it is with diffi- 
culty that the child can nurse, and sometimes this becomes im- 
possible. Occasionally the disease spreads until the greater 
part of the mouth is affected. Usually there is some disturb- 
ance of the nervous system, and more or less fever, the stomach 
is usually irritable and the bowels irregular. 

Treatment. — The Compound Powder of Rhubarb and Po- 
tassa in infusion, should be administered until it acts on the 
bowels once or twice ; or, if there is marked irritation of the 
stomach, with much constitutional disturbance, an emetic 
should be first given. If there is febrile action to any con- 
siderable extent, Tinctures of Veratrum and Aconite, equal 
parts gtts. x, to Water, 3iv, may be given in doses of a tea- 
spoonful every hour. As a local application, the mouth- 
washes named under the head of simple stomatitis may be 
used. 

Where the disease persists after this treatment, give the 
little patient Quinia and Chlorate of Potash. In severe cases, 
an application of one part of dilute Sulphuric Acid to fifteen 
or twenty parts of Honey may be used, the ulcerated surfaces 
being occasionally brushed over with it, or, Gallic Acid in 
solution, or finely powdered Tannin sprinkled on the ulcers, 
may be used. Dr. Jenner recommends a solution of Sulphite 
of Soda, 3j. to 3j of Water ; he supposes the disease due to 
a parasite which this destroys. 



ULCERATIVE STOMATITIS. 

This is a disease of childhood, but is sometimes met with in 
the adult. It occurs chiefly in children who have not been 
well nourished, those that live in damp, unhealthy places ; but 
not invariably, as some of the worst cases I have met with 
have been those in good circumstances, having all the comfort3 
of life. 

On examining the mouth, we find the gums red, swollen and 
spongy, and where the ulcer is situate, a greyish, pultaceous 



218 The Eclectic Practice of Medicine. 

material, on removing which, the surface is raw and bleeding. 
It generally commences on the front part of the gums, but 
gradually passing between the teeth, affects the posterior 
surface ; continuing, it destroys the gum both before and 
behind, and passing to the lips and cheeks adjacent, forma 
irregular ulcerations covered by the same material. If it con- 
tinues long, the tongue is swollen and is marked by the teeth, 
the saliva becomes thick and very offensive, often streaked 
with blood, the gums bleeding at the slightest touch. The 
stomach is usually deranged, the bowels irregular, the tongue 
covered with a dirty coat, and more or less febrile action. 

Treatment. — In the commencement of the disease, Chlorate 
of Potassa internally and as a wash, seems to be almost a 
specific. It should be administered in doses of three grains 
every four hours, and the mouth washed sufficiently often to 
keep it clean ; from six to ten days are usually sufficient to 
effect a cure. If the disease is of longer standing, the mouth 
offensive, and the stomach deranged, it is best to premise with 
an emetic, followed by Compound Powder of Rhubarb to 
move the bowels once, and then give the Chlorate of Potassa, 
succeeded with bitter tonics. In these cases, it will be neces- 
sary to apply the officinal Dilute Nitric Acid to the ulcers 
with a camel's hair pencil; it should be applied daily until 
marked amendment is perceived. Dr. Mackenzie recommends 
the Sesqui-carbonate of Ammonia, in full doses in place 
of the Chlorate of Potassa, and I have no doubt from my 
experience with the preparations of Ammonia in diphtheria 
in scarlet fever, that it will answer an admirable purpose. 



MERCURIAL STOMATITIS. 

This is the most common form of manifestation of chronic 
mercurial poisoning. It may follow the administration of 
Mercury in a short time, or not for months or years, and may 
be occasioned by the smallest, as well as by the largest, dose 
of the mineral. It is rarely met with now, since Mercury is 
going out of date, but formerly it was of frequent occurrence. 
The symptoms are, to some extent, like those in the last form. 
The mouth feels unusually hot, and is sometimes sensible of a 
coppery or metalic taste; the gums are swollen, red, and 
tender ; ulcers make their appearance and spread in all direc- 



Gangrenous Stomatitis. 219 

tions ; the saliva is thick and stringy, and has that peculiar, 
offensive odor characteristic of mercurial disease; the tongue 
is swollen and stiff, and there is some fever, with derangement 
of the secretions. The disease progressing, it destroys every 
part that it touches, until the lips, the cheeks, and even the 
bones, have been eaten away before death comes to the 
sufferer's relief. 

As the disease is produced by a specific poison, it is desir- 
able to use means to counteract it. Sulphur has been employ- 
ed for this purpose, and is the only agent that seems to exert 
a specific action. It may be given in powder, or as dilute 
Sulphuric Acid, or Sulphate of Iron, and also used as a bath 
if desirable. The ulcers should be touched daily, with the 
dilute Sulphuric or Nitric Acid as heretofore named, it being 
freely and thoroughly employed, and a soothing astringent 
gargle, as 5*, Solution of per Sulphate of Iron 31J ; Glycerine, 
5ij : or, a lotion of Borax and Honey. The strength should 
be supported by the use of tonics and stimulants, nutritious 
and easily digested food, and moderate exercise. 



GANGRENOUS STOMATITIS. 

Cancrum oris may follow stomatitis ulcerata, previously de- 
scribed, in which case the ulcers assume a phagedenic charac- 
ter and spread rapidly, destroying all tissues that they come 
in contact with. The secretions of the mouth are excessively 
foetid, the stomach and bowels irregular, and the little patient 
very much prostrated; if it is not speedily arrested, it passes 
to a fatal termination. 

True gangrenous stomatitis commences with a swelling and 
hardness of the cheek and lip, the tumefaction externally hav- 
ing a blanched glossy appearance. On examining the mouth 
we find but little tenderness, the part swollen being slightly 
redder than usual, and having in its centre an ash-colored 
eschar. The tongue is pale and somewhat loaded, the stomach 
and bowels deranged and there is marked exhaustion and 
cachexia, with languor and restlessness. 

The eschar soon spreads, sometimes extending to the lips 
and gums, and is attended with a copious discharge of saliva, 
which soon becomes. turbid ; the breath is very offensive. The 
integument next becomes affected, a small vesicle or pale ashy 



220 The Eclectic Practice op Medicine. 

spot forming, soon becomes livid and sloughs. The ulceration 
now spreads rapidly, destroying the muscles, integument, and 
bones, until sometime previous to death the child could not be 
recognized. 

Treatment. — In the early stage I should commence the 
treatment by the administration of an emetic, following it 
with Quinia in full doses, Chlorate of Potassa, and the mine- 
ral acids. As a local application externally, there is nothing 
better than a Terebinthinate embrocation, or, if sloughing is 
feared, Sulphate of Zinc 3j, to Water 3ij. The ulcer should 
be penciled freely once a day, with the dilute Nitric or Sul- 
phuric Acid, being careful to reach all parts of it, or, if severe 
use the strong acid. This may be followed by washes of Chlo- 
rinate of Soda, Chloride of Lime, or Creosote, with Camphor 
and Myrrh ; pure air, nutritious diet, and perfect cleanliness, are 
important elements of success. 



NURSES' SORE MOUTH. 

Some years ago, a sore mouth prevailed extensively among 
nursing females ; of late, it has become rare in this section, 
though in some parts of the country it is still prevalent. It 
usually commenced some days after confinement, but occasion- 
ally made its appearance in a mild form during the last period 
of gestation. It was frequently preceded by heart-burn, or 
pyrosis, sometimes during the entire progress of gestation. 
The first indications of it, were a feeling of heat in the mouth, 
with slight tenderness, and increased secretion of saliva, which 
seemed to irritate the inflamed surface. 

On examination the mouth would be found reddened, the 
mucous membrane tumefied, and where the disease had become 
severe, small vesicles terminating in ulceration would make 
their appearance ; commencing on the lips or tongue it would 
gradually pass back until it involved the entire mucous mem- 
brane, and in some cases extend to the pharynx, the oeso- 
phagus, and finally pass through the entire intestinal canal. 

In these cases as the disease advanced, it would produce 
marked irritation of the parts invaded, of the stomach and of 
the bowels, occasioning great prostration from arrest of diges- 
tion. It would sometimes last during the entire period of 
nursing and only cease when the child was weaned. 



Dysphagia. 221 

Treatment. — To relieve irritation and arrest acidity of the 
stomach, I employed the Compound Powder of Rhubarb in 
small doses, and gave the Chlorate of Potassa, in doses of a tea- 
spoonful of the saturated solution, every three or four hours. 
The Iodide of Potassa, in doses of five grains every four hours 
answered a good purpose in some cases, but in others it failed. 
Occasionally an infusion of equal parts of Alnus, Rumex and 
Quercus Rubra, administered internally and also used as a 
wash, would cure the disease when other means failed. As a 
local application, the Chlorate of Potassa was used with marked 
advantage, but in some cases its influence was not perma- 
nent ; all of the milder mouth washes heretofore named, were 
employed with but temporary relief. Some practitioners used 
a solution of Mtrate of Silver grs. xx to grs. xl to the 3j of 
Water, and spoke highly of it. After trying various, means, I 
finally discarded all mouth washes, using the general treatment 
above named, and recommending the smoking of Tobacco 
three or four times a day. This though an unpleasant treatment 
was uniformly successful, the disease in some cases being radi- 
cally cured, but in others requiring a resort to the remedy 
every few days or weeks. 



DYSPHAGIA. 

The act of deglutition is performed by the fauces, pharynx, 
and oesophagus, hence dysphagia, or difficulty of swallowing, 
becomes one of the most prominent symptoms of disease of 
these parts. The causes of dysphagia are varied and may be 
summed up, as follows : 1st, From disease of the fauces, ton- 
sils, or palate. 2d, From inflammation of the pharynx or 
oesophagus, or from local suppuration. 3d, From disease of 
the larynx. 4th, From paralysis of the muscles. 5th, From 
spasmodic stricture of the oesophagus. 6th, From structural 
change, stricture, ulceration, cancerous disease and pressure of 
adjacent parts, as from presence of aneurism or other tumors. 

Dysphagia from the first named causes needs but to be men- 
tioned at this place, as we have considered these diseases 
heretofore, as also the principal diseases of the pharynx. 

Inflammation of the cellular tissue of the pharynx and cesopha- 
gus, is of rare occurrence, but may result from injury, or from 
pyaemia. In this case there would be marked constitutional 



222 The Eclectic Practice of Medicine. 

disturbance, more or less dyspnoea and great difficulty of swal- 
lowing. If the inflammation was diffused, the patient would 
pass rapidly into a typhoid condition, with extreme dysphagia. 
Examination of the neck and throat would enable us to 
determine the character of the difficulty. 

The treatment should be active, a brisk cathartic, an alkaline 
diuretic, with a suitable portion of the special sedatives, would 
form the internal treatment. The hot Mustard foot bath, with 
the general bath and sinapisms to the spine, would be valuable 
adjuvants. The neck should be freely cupped and scarified, 
followed by warm applications. If pus should form, the dys- 
phagia being great, and the constitutional symptoms severe, it 
is necessary to give it an outlet even though deeply seated. 
The system becoming much depressed, it should be supported 
by the employment of Quinia, the free use of stimulants, and 
nutritious food. 

Diseases of the larynx give rise to dysphagia only when there 
is necrosis of the cartilages, and contingent inflammation and 
suppuration of the adjacent cellular tissue, except in very 
severe laryngitis, and in syphilitic ulceration, affecting the 
epiglottis. Severe dysphagia sometimes occurs in chronic 
phthisis from ulceration of the epiglottis, and is one of the 
most trying complications of the complaint. This may be 
mitigated to considerable extent by the inhalation of the va- 
por of Vinegar, or of Iodine; and sometimes by the use of a 
strong solution of Nitrate of Silver, directly applied to the 
parts affected. 

Paralysis of the muscles may result from laryngitis, from 
shock, or from cold as in aphonia. It is usually but partial, 
the act of swallowing being performed with marked difficulty, 
owing to want of action of certain groups of muscles. I recol- 
lect one case in which for some weeks, the patient could swal- 
low only as he would grasp the larynx with the hand and ele- 
vate it. This may be removed in many cases, by the use of 
stimulant local applications to the pharynx, as Tincture of 
Myrrh, Capsicum, Nitrate of Silver, etc. Or, Electricity may 
be used with advantage, passing the current from the spine 
through the affected muscles. Internal remedies may be em- 
ployed, as the Extract of Nux Vomica, Ergot in doses of five 
grains four or five times a day, or the infusion in larger doses; 
the Ehus Toxicodendron and Staphisagria, may sometimes be 
employed. 



Acute Gastritis. 223 

Spasmodic stricture of the (Esophagus occurs principally in 
young persons of a nervous habit, and most frequently in 
females when there is irregularity of the menstrual function, 
impaired digestion and hysteria. "We recognize it from its 
sudden appearance, and the condition of the patient; spasmo- 
dic stricture sometimes is present during organic diseases of 
the oesophagus, greatly aggravating the patient's condition. 

Treatment. — The use of fluid food for some time, demul- 
cent drinks, with Tincture of Gelseminum in doses of twenty 
drops every three hours, with aperient enemata and hot fomen- 
tations will usually afford relief in a short time. A tonic and 
anti-spasmodic treatment should then be adopted, as of Quinia, 
Hydrastine and Bromide of Ammonium, with means to reg- 
ulate the menstrual function, if a female; out door exercise 
with cheerful occupation of the mind, and the daily use of a 
salt-water bath, with brisk friction to the spine, will materially 
aid the treatment. 

Structural changes of the oesophagus. — Dysphagia may be 
the result of annular constriction, ulceration, cancer, and 
pressure from aneurismal or other tumors. The history and 
close attention to the symptoms, will alone enable us to dis- 
tinguish these cases from one another. In these no permanent 
relief can be obtained, and we have simply to palliate the symp- 
toms as they arise. 



ACUTE GASTRITIS. 

Acute inflammation of the stomach is of rare occurrence 
except as the result of poisoning by the irritant acro-narcotic 
poisons. Arsenic, Corrosive Sublimate, Oxalic Acid and the 
mineral acids, are those of this class most frequently used. 

Symptoms. — The symptoms of acute gastritis vary greatly. 
In some cases there is no pain, but a feeling of intense de- 
pression, a small thread-like pulse, cold extremities, and a 
cold, clammy perspiration. In other cases the pain is most 
intense, burning, pungent or lacerating ; there are violent retch- 
ings aggravating the suffering, the matter vomited varying 
with the contents of the stomach; the patient has an intense 
desire for water, but when taken it is seen to bring on the vom- 
iting. The breathing is shallow and increases the pain, the 
patient lies on the back, with the feet drawn up, to take off the 
pressure of the abdominal muscles. The skin becomes hot 



224 The Eclectic Practice of Medicine. 

and dry at an early period, the tongue is red, the epigastrium 
tumid and tender, the pulse constricted and small, and the 
bowels costive. As the disease increases, all these symptoms 
become aggravated, the patient is delirious, or coma comes 
on, and he shortly dies. 

Treatment. — When called to a case of poisoning by the 
irritant poisons, the first object is to remove the agent from 
the stomach as speedily as possible. Generally, emesis results 
from the poison, and we have simply to give large quantities 
of some demulcent to wash the stomach out thoroughly, and 
at the same time use the proper antidote if one is known. If 
vomiting has not occurred, it is much better to use the stom- 
ach-pump, and to avail ourselves of all means to quiet the 
stomach. 

The first few hours having passed, we have to turn our 
attention to the relief of the acute inflammation of the stom- 
ach, and in some cases to neutralize the influence of the poison 
upon the system. Small quantities of ice-cold mucilaginous 
fluid may be administered, and ice given to the patient occa- 
sionally; the infusion of Peach-tree Bark as heretofore 
recommended will be found useful, as will sometimes the use 
of Hydrocyanic Acid and Morphia, or Sub-Xitrate of B\smuth ; 
cups should be applied to the epigastrium, and followed with 
either hot fomentations or cold applications, as best relieves the 
pain. The bowels should be moved by an enema, sometimes 
one of a stimulant character having a marked influence in 
checking the nausea and vomiting. 

As the patient is very much prostrated, it would seem that 
stimulants and food should be taken as soon as the nausea is 
checked. This must never be allowed, as a small quantity of 
ingesta will frequently cause a return of the severe symptoms. 
If there is imminent need of stimulants, 3ss of Brandy may 
be used as an injection, and repeated as often as necessary; 
Beef Tea and Milk may be used in the same manner. In 
some cases, after the lapse of a day or two, small doses of 
Turpentine or Creosote have been used with advantage, espe- 
cially where there was hemorrhage. 



Catarrhal Gastritis. 225 

CATARRHAL GASTRITIS. 

Under this head we may group the very large class of in- 
flammations of the stomach, which, while they can not be 
termed acute, as regards the intensity of the inflammation, 
are yet so as regards their duration if not improperly treated. 

The causes are various : it may arise from cold, as other in- 
flammations; or from intemperance in eating or drinking — 
which is a very frequent cause, especially in cities; or from 
some change in the blood, as in retention of urea, the menstrual 
discharge, or the introduction of an animal poison from with- 
out; and from sympathy with adjacent organs. It also occurs 
as a complication during other forms of disease, as heretofore 
described. 

Symptoms. — The patient complains of a sense of uneasiness, 
heat, and pain at the epigastrium, which are greatly increased 
by taking food, or sometimes fluids; there is nausea with 
retching and vomiting, especially after taking any considerable 
quantity of either food or drink into the stomach; flatulence 
and distension, with a sense of heat, or acridity and unpleasant 
sensation in the throat and fauces is common, and acrid or ran- 
cid eructations frequently occur. If vomiting occurs, the matter 
brought off the stomach is generally ropy, colorless and abund- 
ant, or colored by bile of a yellowish or greenish hue. 

" Chilliness or slight shivering often precede and attend the 
pain and vgmiting, with a sense of anxiety at the prsecordia; 
and tenderness, fullness and distension of the epigastrium; 
depression of spirits and of strength, a dark or sallow circle 
around the eyes, a loaded tongue, the point and edges being 
red or indented by the teeth, or the surface more generally 
red, and the papillne elevated, with great thirst and desire for 
cold fluids. The bowels are costive, and the urine is scanty, 
high-colored, and generally presents an acid reaction. The 
pulse is frequent, soft or broad, open or compressible; the skin 
dry and feverish; the breathing is frequent and shallow, and 
the patient either sits up for a time, or lies on his back in bed. 
All kinds of food, especially animal food, are loathed; or, 
when tasted, excite nausea and vomiting, which generally also 
follows warm drinks, especially tea." — (Copland.) 

Treatment. — The constipation of the bowels should be over- 
come by laxative enemata, as one means of revulsion; cups 
may be applied to the epigastrium, and followed by the irri- 
15 



226 • The Eclectic Practice of Medicine. 

tating plaster, or the wet bandage. The warm bath is 
attended with marked benefit, but if this can not be used, the 
vapor bath, occasionally followed by the cold sponge bath, or 
the wet sheet pack, answers admirably. Demulcents intern- 
ally are very useful, but should not be made to take the place 
of important remedies, if any are constantly used. I would 
recommend the Althse, which answers the additional purpose 
of increasing the urinary secretion — a very important matter 
in some cases. 

At first, small doses of an infusion of Peach-tree Bark, with 
ice to check the thirst, and minute doses of Morphia, with a 
weak solution of Nitrate of Potassa or Citrate of Ammonia are 
useful. In cases where the vomiting is very severe, especially 
if there is some hemorrhage, small doses of Turpentine, with a 
Turpentine stupe to the bowels, is highly recommended. The 
Sub-nitrate of Bismuth occasionally answers a good purpose, as 
does an infusion of the Compound Powder of Rhubarb. The 
active symptoms having subsided, counter-irritation with the 
irritating plaster, and the use of mild tonics may be con- 
tinued until the cure is complete. 



CHRONIC GASTRITIS. 

This is frequently a continuance of the acute disease last 
described, but many times it results from intemperance in eat- 
ing or drinking, especially overburdening the stomach, which 
may be readily done at times, when the system is exhausted, 
even if there has been no previous tendency to disease. 

Symptoms. — In this affection we have the evidences of im- 
perfect digestion and nutrition, in the loss of strength and 
flesh, and the languor the patient complains of; continuing, it 
causes derangement of the bowels, the skin and kidneys; 
headache is of frequent occurrence, and neuralgic pains not 
uncommon. The nervous system is deranged, the patient is 
irritable and fretful, has many imaginary diseases, which to 
him are a source of great alarm. 

The symptoms referable to the stomach are often those of 
indigestion, a feeling of tension, with heartburn and sometimes 
nausea after the food is taken. When the stomach is empty, 
there is a sense of gnawing, of craving, or of sinking, which 
is extremely unpleasant, and sometimes causes the patient to 



Chronic Gastritis. 227 

be taking food frequently through the day, to the great detri- 
ment of the disease. Sometimes there are acrid or foul eructa- 
tions for hours after a meal is taken, which occasionally do 
not subside until the stomach is relieved by emesis. 

Diagnosis. — We diagnose a chronic gastritis by the symp- 
toms of imperfect digestion above named, by the loaded or 
furred tongue, its tip and edges being red, by the epigastric 
tenderness, and the severe constitutional disturbance. 

Prognosis. — If ulceration has not taken place, the prognosis 
may be considered favorable, except in those cases in which 
it is the result of intemperance. 

Post-Mortem Examination. — The lesions of the stomach 
are not very marked ; the mucous membrane is usually of 
a reddish-brown or dull-grey color, with sometimes livid dis- 
colorations ; there is usually thickening and induration of 
the mucous membrane, sometimes extending to the entire 
coats, and more marked at the pyloric orifices. 

Treatment. — Time and perseverance are important ele- 
ments in the treatment of chronic gastritis, the less the 
hurry, usually, the better the patient will get along. If the 
stomach is very irritable, and digestion feeble, the blandest 
articles of food should be selected and taken in as small 
quantity as will support the strength ; too much importance 
can not be attached to this ; for the stomach, I have used 
the infusion of Peach bark in doses of a teaspoonful every 
hour, an infusion of the Cornus Florida, of the Collinsonia, 
of the Coptis, and agents of like character, with marked 
advantage. If there are acrid eructations, the Sub-nitrate 
of Bismuth ; if increased secretion of mucus, with nausea, 
the Oxide of Zinc in doses of one grain every five or six 
hours will be useful. 

The irritating plaster should be applied to the epigastrium, 
and renewed every day, or every other day, until a crop of 
pustules is produced ; it may then be removed and the part 
dressed with simple Cerate, until the irritation disappears, 
when it should be re-applied. In some cases it is well to 
continue it so as to produce free suppuration, but usually the 
plan above named will prove the best. This application, it 
has seemed to me, has accomplished more in this disease than 
all other remedies combined. 

"When the irritation has subsided to some extent, the milder 
bitter tonics, as the Hydrastis, may be employed with great ad- 



228 The Eclectic Practice of Medicine. 

vantage. In some cases, there seems to be a want of innerva- 
tion to the stomach, and I then use Nux Vomica, as #, Extract 
of Nux Vomica, grs. iv ; Hydrastin, 3ss ; Extract of Taraxicum, 
q. s.; M., and make thirty pills, of which one may be taken 
three or four times daily. The liver is deranged in nearly all 
these cases, most generally torpid, though sometimes too 
active. In the first case, the administration of Leptandrin in 
doses of one or two grains two or three times a day, or Po- 
dophyllin, thoroughly triturated with white Sugar, in doses 
of one-sixth to one-eighth of a grain, with one grain of 
Dioscorin, answers an admirable purpose. Sometimes the 
stomach will bear well the Podophyllin pill, in doses of a half 
grain, with Extract of Hyoscyamus at night ; or, we may use 
in these cases, the Compound Tincture of Corydalis ; the 
Essl. Tinctures of Cornus and Collinsonia, with Glycerin, 
equal parts, answers a good purpose to alternate. 

If there is marked derangement of the kidneys, it is better 
to direct the treatment to them, as until free secretion is 
established, it is impossible to favorably affect the stomach. 
If there is feeble digestion, a solution of Pepsin formed by 
digesting the stomach of a calf in a pint of Sherry wine for 
ten days, may be used in doses of a tablespoonful after meals. 



ULCERATION OF THE STOMACH. 

Ulceration of the stomach may be divided into three varie- 
ties; superficial ulceration, follicular ulceration, and chronic 
or perforating ulcer. The symptoms of ulceration of the 
stomach are rather obscure, and there are no well defined evi- 
dences by which we can distinguish one from another; the 
distinction, therefore, is post-mortem. 

Superficial Ulceration. — According to Habershon, the 
symptoms are, vomiting, pain at the scrobiculus cordis, pyro- 
sis, loss of strength, or great prostration. The great prostra- 
tion of strength was a marked symptom, and a most inter- 
esting one, taken in connection with the intimate union of 
the stomach with the large plexuses and ganglise of the sym- 
pathetic nerve. The association of some cases of superficial 
ulceration with pyaemia, appears to show that a general dis- 



Ulceration of the Stomach. 229 

eased condition of the blood predisposes or excites this change. 
Hematemesis sometimes occurs. In those cases following 
portal congestion, vomiting of coffee-grounds substance took 
place several days before death. These cases were connected 
with renal anasarca and diseased heart, or with cirrhosis. 

Post-Mortem Examination. — The mucous membrane is foul, 
congested, especially the rugae, and changed in color. The 
ulcers vary in number, usually about one fourth of an inch 
in diameter, with rounded, irregular edges, and extending 
through the mucous membrane; they are more numerous 
near the pyloric orifice, sometimes seeming to have destroyed 
nearly the entire mucous membrane. 

Follicular Ulceration. — The symptoms of follicular ulcera- 
tion of the stomach are very similar to those of chronic gas- 
tritis. It is generally met with in children, when it is usually 
attended with diarrhoea, being one of the forms of cholera 
infantum. It is especially recognized by the great irritability 
and restlessness of the child, the dry mouth, furred tongue, 
red at tip and edges, tenderness on pressure over the epigas- 
trium, pinched appearance of the countenance and excessive 
and persistent irritability of the stomach. Occasionally 
hemorrhage occurs, and we have the vomiting of coffee- 
ground looking matter. 

Post-Mortem Examination, shows a condition of chronic 
inflammation, the mucous membrane thickened and discolored, 
with very many minute points of ulceration seeming to be 
situate in the gastric follicles. 

Chronic and Perforating Ulcer. — Chronic ulceration is 
the result of long continued inflammation, so that it is preceded 
(unless occasioned by injury when it may be acute) by the 
symptoms heretofore named. Sometimes no other symptoms 
present themselves, but usually the pain is more severe, at 
times intense. Vomiting of food is the most marked evidence 
of chronic ulceration, if we except hemorrhage; the period 
at which it occurs is variable, sometimes the food is at once 
rejected, but usually from one to four hours elapse; at times a 
meal is completely digested, the vomiting occurring afterwards, 
or stopping with slight nausea and retching. Hemorrhage, 
though tending to confirm the existence of ulceration, is not 
pathognomonic as some would suppose, as it may occur from 
congestion, determination of blood and malignant disease. 
Chronic ulceration, though a severe disease, is not necessarily 



230 The Eclectic Practice of Medicine. 

or speedily fatal; in many cases the patient may be around, in 
others the disease will continue for years. It terminates 
fatally : 1st, from gradual exhaustion ; 2d, from hemorrhage ; 
and 3d, from perforation of the peritoneal cavity. 

Perforating ulcer presents the symptoms already named up 
to the period of perforation. When this occurs the pain in 
the epigastrium becomes excruciating, which in turn extends 
to the entire abdomen ; in some cases there is nausea and 
vomiting, but in others these symptoms are absent ; there is great 
prostration, a livid and contracted countenance, coldness of 
extremities, and a feeble pulse; occasionally there is severe 
hemorrhage. The disease may terminate fatally in a short 
time, or, it may continue for several days, or, even two or three 
weeks, or, in rare cases, the patient may recover. 

Post- Mortem Examination. — In chronic ulceration, the ulcers 
are found principally near the pyloric orifice, they vary in 
size from half an inch to three inches, are usually round, with 
elevated and well defined edsres. There is tumefaction of the 
mucous membrane, and thickening of the sub-mucous cellular 
tissue. If perforation has occurred, the opening through the 
mucous membrane is largest, and that through the peritoneum 
is smallest. In some cases efforts towards a cure are observed, 
the stomach becomes attached to adjacent viscera by adhesion, 
and inflammation and partial cicatrization of the ulcer takes 
place. In cases of non-perforating ulcer, the form of the 
stomach is sometimes changed, from the contraction of plastic 
material thrown out for the repair of the part. 

Treatment. — In a majority of cases the treatment will be 
the same as for chronic gastritis. In some cases the Oxide of 
Zinc with a small portion of Opium and Leptandrin seemed to 
act well. Dr. Brinton recommends ten or twenty grains of 
Tris-nitrate of Bismuth, with five or ten grains of Compound 
Kino Powder, in cases of diarrhoea. The best remedy for 
hemorrhage is Gallic Acid, two grains dissolved in an ounce 
of water, with the aid of ten drops of Sulphuric Acid. The 
irritatiug plaster or other means of counter-irritation must 
not be neglected, and the strictest attention paid to diet. Illus- 
trative of the treatment, I may quote from Dr. Bennett : " The 
remedies I have found most efficacious, in simple chronic ulcer 
of the stomach, are quietude, careful regulation of the diet, 
Bismuth and Opium Pills and Powders, and sometimes warmth 
at others cold applied locally. It may be frequently observed 



Stricture op the Pylorus. 231 

that the mere coming into a hospital, and remaining quietly 
in bed, has a favorable effect in modifying the distressing 
symptoms. I have also remarked that those patients who are 
always getting up and walking about, suffer much more than 
those who remain in bed, especially at the commencement of 
the disease, hence, repose in an easy position, is to be enjoined. 
The diet should consist of farinaceous, pulpy substances, occa- 
sionally mixed with beef tea, or milk, given in small quantities, 
frequently repeated. If the stomach will not tolerate the food 
warm, it should be given cold. "When, despite this treatment, 
vomiting continues, it is best to suspend all nourishment for a 
day or two, and give nutritive enemata. As the patient gets 
better, the amount of solid food should be very cautiously 
increased. Thirst is a distressing symptom in such cases, and 
is best allayed by allowing ice to dissolve in the mouth slowly, 
or sipping at intervals, milk and lime water mingled in equal 
proportions. The .pain is alleviated best by Bismuth and 
Opium, combined in the form of pills or powder. Sometimes 
local warmth, but more frequently pounded ice, mixed with 
salt in a bladder, applied over the part will give relief. Two 
or three leeches, or a counter-irritant, may succeed, when every 
thing else fails, and should be tried. Quietude and suspending 
all ingesta for a time, I believe to be the best remedies for 
hemorrhage, and when exhaustion from want of food exists, 
nutritient enemata, with wine, must be administered. "When 
a perforation occurs, I have already pointed out the great 
importance of avoiding the giving of stimuli by the mouth, 
and have stated the practice which should be perseveringly 
followed, namely, the administering Opium in the form of pill, 
quietude, avoidance of purgatives, and nourishing at first by 
enemata, and then cautiously by non-irritating substances, 
given in small quantity by the mouth." v 



STRICTURE OF THE PYLORUS. 

Stricture of the pylorus is usually the result of hypertrophy 
of all the tissues at this point, but rarely it may be found when 
these are normal. The source of this difficulty is obscure, but 
we have reason to believe that it is the result of long continued 
irritation, or chronic inflammation, the symptoms of which 
have preceded it. The symptoms are common to this, to can- 



232 The Eclectic Practice of Medicine. 

cer and some cases of ulceration. There is dyspepsia with pain 
in the epigastrium, and vomiting after eating. Of course the 
long continuance of imperfect action of the stomach, will give 
rise to marked debility, and to functional derangement of the 
organs; occasionally the enlarged pyloric extremity can be 
plainly felt through the abdominal walls, when, if there are 
no evidences of a cancerous cachexia, we may conclude that 
we have stricture with hypertrophy. 

As regards the treatment, we can do nothing but palliate 
the symptoms as they rise. The relief of irritation may check 
the progress of the disease, and this may be sometimes afforded 
by the means heretofore named. The food should be princi- 
pally liquid, and easily digested, and taken in small quantities 
at a time. Harsh treatment, or the administration of tonics 
and stimulants should be studiously avoided, and in this way 
the patient's life may be prolonged for a considerable time. 



CANCER OF THE STOMACH. 

The stomach is one of the organs most frequently affected 
with cancer, every form of the disease being observed, but 
schirrus and medullary are most frequent. 

The disease is most frequently found at the pyloric ex- 
tremity, and originates in the mucous membrane. In its 
progress it invades all the tissues, and finally they are resolved 
into a cancerous mass. The disease extends in the course of 
time affecting the adjacent glands, the pancreas, duodenum, 
in fact all parts contiguous. 

Symptoms. — The symptoms of cancer, in the early stage are 
very obscure, being those common to the diseases interfering 
with the functions of the organ heretofore named. There 
may, or there may not be pain, when it exists, and may be 
sharp and lancinating, or dull, twisting and heavy; sometimes 
it is most severe after taking food, but at others when the 
stomach is empty. "When the disease has obtained consider- 
able development, vomiting is generally the most prominent 
symptom, coming on a short time, or several hours after eat- 
ing. The material thrown off the stomach is usually frothy 
and fermenting, and contains the sarcina ventriculi. In its 
later stages, the cancerous mass can generally be tolerably 
well defined, the health is very much shattered, and the pa- 



Cancer of the Stomach. 233 

tient presents that peculiar dull-yellowish appearance, denot- 
ing a cancerous cachexia. The pain is now very intense, and 
constantly requires means to alleviate it ; digestion is very 
imperfect, vomiting coming on immediately when the stom- 
ach is distended to any considerable extent, and almost always 
before digestion is accomplished. Thus the patient is grad- 
ually worn down by physical suffering, and the want of nour- 
ishment. 

Diagnosis. — As before remarked, it is difficult to distinguish 
between these diseases of the stomach, yet with care a very 
accurate diagnosis may be formed. We would diagnose can- 
cer from inflammation, by the fact that the latter extends over 
along period of time, while cancer develops itself in from three 
to twelve months, and runs its course in from one to three 
years ; vomiting of blood occurs in ulceration, but rarely in 
cancer until the last ; ulceration is frequently amenable to 
treatment, cancer is not; then there is the additional evidence 
of the enlargement of the epigastrium, and cancerous cachexia. 
The last would be the only point by which we could deter- 
mine between the malignant and non-malignant enlargement 
of the pylorus. 

Treatment. — As we can not expect to cure the disease, the 
treatment will be such as will palliate the symptoms, and if 
possible retard the growth of the cancer. The measures 
named under the head of ulcer of the stomach, will be appro- 
priate, especially those quieting irritation. Ext. Conium, with 
an infusion of Peach-tree Bark, has seemed to answer a better 
purpose in two cases that I have treated, than any other rem- 
edies. The Sub-nitrate of Bismuth with Opium ; the Oxide of 
Zinc; Tincture of Perchloride of Iron one part, to Glycerine 
two parts, with the addition of Morphia, is advantageous. 
When not too irritating, a solution of Tannin may be used 
freely, relieving many of the most unpleasant symptoms, and 
arresting to some extent the growth. The disease will have 
to be treated much on general principles, meeting the indica- 
tions as they arise, though, at last, it resolves itself simply into 
the administration of Opium and Morphia. 



234 The Eclectic Practice of Medicine. 

DYSPEPSIA. 

Under this head we may group the entire class of functional 
disorders of the stomach, which are primary in their origin, 
and not dependent upon structural change. 

Difficult or imperfect digestion, is one of the most frequent 
ailments we meet with in practice, and requires more dis- 
crimination for its successful treatment. This will be more 
apparent if we notice those conditions that are necessary to 
healthy digestion ; they are : 1st, A proper quantity and qual- 
ity of ingesta ; 2d, Thorough mastication and insalivation ; 
3d, Normal action of the muscular coat of the stomach, 
giving the food proper motion ; 4th, A proper quantity and 
quality of the gastric juice, and of the pancreatic and biliary 
fluids; 5th, Normal innervation, and healthy condition of the 
blood ; and, 6th, A reciprocal action of the intestinal canal. 
Dyspepsia may be the result of a failure of any of these con- 
ditions, or a partial failure of two or more of them, so 
that very different causes may give rise to a similar result. 

Habershon classifies the causes of dyspepsia, as: "1st, From 
abnormal condition of the mucous membrane and its secretion ; 
2d, From the muscular movements being impeded ; 3d, 
From the state of the vascular supply; 4th, From the con- 
dition of the nervous system ; and lastly, From the character 
and changes that take place in the food. Several of these 
causes of dyspepsia may be combined; some lead to disease of 
a very transient form, others are irremediable." 

The mucous membrane may be affected in various ways : 
Thus, we may have atrophy, especially of the follicles, the 
change at last becoming so great that digestion can not be 
accomplished, and the patient necessarily dying of marasmus. 

Again we find other cases in which there is undue activity 
of the mucous glands and of course deficient action of the 
gastric follicles, hence we have two conditions either of 
which if considerable would materially interfere with diges- 
tion. This condition is frequently observed associated with 
chronic disease, as in anaemia, chlorosis, chronic bronchitis, 
and other chronic affections of the mucous membranes. As 
an independent affection, the symptoms are a feeling of weight 
and tension in the epigastric region ; a bad taste in the mouth ; 
foetid breath ; occasional nausea ; sometimes vomiting, when 
considerable quantities of vitiated mucus may be raised; a 



Dyspepsia. 235 

heavily loaded tongue, especially at the base and in the early 
part of the day ; sometimes there is a disgust for food, and for 
several hours after it is taken, there are unpleasant eructa- 
tions ; at others the appetite is craving, but the patient feels 
uncomfortable after eating. The bowels are usually consti- 
pated, but there are occasional attacks of diarrhoea, in conse- 
quence of imperfect digestion of the food. 

The reverse of this condition may exist, there is scanty 
mucous secretion, with normal or slight excess of gastric 
juice, the result being a continued irritation of the stomach, 
from want of its natural protection. In these cases we have 
heartburn, both after eating and when the stomach is empty. 
There is a feeling of soreness and rawness when distended 
with food, and a disagreeable gnawing and feeling of contrac- 
tion when it is empty. Digestion is not impaired to such an 
extent as it is found in some other cases, yet the symptoms 
are exceedingly unpleasant. 

The gastric juice may be increased in quantity or deficient, 
or, may be changed in quality, being too active, or not active 
enough. In the first instance, though normal in quality, 
the excess impairs digestion, and by its acrid properties 
irritates the stomach and causes pain and unpleasant sen- 
sations. It is this excess that gives rise to pyrosis or water- 
brash. It may be excessive simply by too great dilution; 
The excess may be at the period of digestion, or in the inter- 
val when the stomach is empty; in the first case, there are acid 
eructations with more or less of the partially digested food? 
the last is attended by severe heart-burn. 

If deficient, the causes of imperfect digestion would seem to 
be evident, but this is not the case, for the deficiency may be 
only in one element, as of an acid, or of water, or of pepsin, 
or it may be deficient on account of the intense acridity of the 
secretion irritating the stomach and checking its formation. 
In these cases the symptoms are varied, but there is evidence 
of imperfect digestion, and more or less unpleasant sensations 
at the epigastrium. 

The secretion may be irregular, giving rise to a craving, 
with pain at the stomach, cramp, heart-burn, etc., in the 
intervals between meals, and sometimes nausea and vomiting 
or a burning sensation, and unpleasant eructations, two or 
three hours after eating. This irregular secretion if it con- 
tinues, causes great irritation, sometimes disorganization of 



236 The Eclectic Practice of Medicine. 

the mucous membrane, and may cause its digestion if its 
innervation is enfeebled by injury or severe shock to the 
system. Impaired action of the muscular coat will undoubt- 
edly derange the process of digestion, as it depends to a con- 
siderable extent upon the continual movement and attrition 
of the food. The general symptoms are those common to the 
other forms of dyspepsia, but there is an absence of pain and 
in consequence gaseous accumulations and uneasiness from dis- 
tension. 

The general sluggishness of the system, especially the tor- 
por of the nervous system, and slow action of other organs, 
with obstinate constipation of the bowels, are additional indi- 
cations. The reverse of this is productive of fully as serious 
consequences, as the food is forced through the pyloric orifice 
before stomachic digestion is complete. The result is diar- 
rhoea, with imperfect nutrition, great loss of strength and 
flesh, and if it continues, death from exhaustion. 

Changes in the circulating fluid, may give rise to dyspepsia, 
but they more frequently intensify it by preventing normal 
nutrition of the stomach. All have observed the intimate 
relation existing between the blood and the stomach in acute 
diseases, hence in fever, though the appetite may demand 
food, yet digestion is slow and imperfect ; though usually the 
appetite disappears with the power to digest. In many dis- 
eases in which the blood is loaded with impurities, we find, 
that all means directed to the stomach are inefficient; we 
must first remove the detritus from the blood, and having 
secured a normal circulating fluid, though small in quantity, 
digestion can be again established. Torpidity of the bowels, 
and inactivity of the skin, doubtless affect the stomach in this 
way, in addition to the extension of the derangement by 
continuity of structure and sympathy. 

The most common of these causes of dyspepsia, and one 
that should be carefully watched for in all these cases, is de- 
rangement of the urinary secretion ; I have seen cases in 
which all other means having been exhausted, a treatment 
directed to restore this secretion, has radically cured the dys- 
pepsia. That this is the fact, is proven conclusively, when 
we observe that in every derangement of the kidney of any 
considerable duration, the function of the stomach is one of 
the first impaired. 

Like all other functions, perfect digestion depends upon 



Dyspepsia. 237 

normal innervation ; and in* this case it is dependent upon the 
normal condition of three parts of the nervous system. The 
great sympathetic nerve seems to be the governing power in 
a state of health ; the pneumo-gastric nerve is distributed to it 
to connect it with the heart, lungs and brain, and it is con- 
nected with the spinal cord by communicating filaments to the 
sympathetic ganglise. Disease of any of these sources of inner- 
vation may give rise to dyspepsia, and conversely, disease of 
the stomach may give rise to derangement of these different 
parts of the nervous system. 

Derangement of innervation manifests itself in two prin- 
cipal forms, irritation and atony. The first, as we have 
already noted, may arise in and be confined to the stomach, 
or it may be the result of distant lesions. In the first place, 
we have irritation of peripheral nerves, with determination of 
blood, derangement of secretion, and other results that follow. 
In the last, we have the same effects but the cause is distant, 
as in irritation of the stomach from disease of the brain and 
spinal cord. The severest cases of irritation we ever witness, 
are from this cause, as in some cases of cholera infantum. We 
again see causes in which the irritability of the stomach 
depends upon disease of the spinal cord ; and cases in which 
we are convinced that the lesion is one of the sympathetic 
nervous system, though we are unable to prove it. 

Derangement of the stomach reacts on the nervous system, 
and organs supplied by the same system of nerves. Thus, we 
have hypochondriasis, hysteria, irritation of the spinal cord, 
cough, expectoration, and seeming disease of the lungs, palpi- 
tation and other disordered action of the heart as its result. 

The character of the ingesta is very important as an ele- 
ment of dyspepsia. Food may be taken in too large quantity, 
or the quality may be such as to overburden the stomach ; 
hence its continuance gives rise to imperfect digestive power. 
Abnormal changes taking place in the food may not properly 
be considered a cause of dyspepsia but rather a result, and yet 
serve to perpetuate it. These may be divided into putrefac- 
tive decomposition and the formation of sulphureted hydro- 
gen; simple fermentation giving rise to carbonic acid; fer- 
mentation forming lactic or butyric acids, and the formation 
of sarcenia ventriculi. 

Symptoms. — The principal symptoms have been named as 
we considered each lesion, but we may reconsider them with 



238 The Eclectic Practice of Medicine. 

advantage. Dyspepsia, as we before remarked, is imperfect 
digestion, and from this we have feeble and imperfect nutri- 
tion, and the results that flow from it, derangement to a 
greater or less extent of all the functions of the body, and 
Joss of flesh and strength. Unpleasant sensations in the 
region of the stomach are always present in some degree, 
but vary as regards 4 ' its condition; pain, burning, sense of 
soreness, tension, fullness, weight, tenderness on pressure, are 
the principal ones, and for the diagnostic bearing of them I 
would refer to the preceding description. 

Prognosis. — The prognosis may be favorable in a large ma- 
jority of cases, if the patient's appetites can be controlled for 
a sufficient length of time ; if not, medicine will but palliate 
the disease, or remove it for a time. In some cases a cure is 
impossible, relief of the most unpleasant symptoms being all 
that can be expected. 

Treatment. — In the first case named treatment will be of 
little avail, as the structure having become atrophied will not 
respond to the action of medicines ; relief may be obtained by 
the administration of the gentle bitter tonics, and stimulation 
by Nux Vomica or Strychnia. Digestion may be greatly 
aided by the administration of Pepsin after meals. I use 
it as before named: take the stomach of a calf, cut it in small 
pieces, and digest it for ten days in a pint of Sherry or Ca- 
tawba wine ; from a tea to a tablespoonful may be taken after 
each meal, and repeated in an hour or two, if necessary. 

When the symptoms indicate excessive secretion of mucus, 
or where there is fermenting or decomposing food in the stom- 
ach, a thorough emetic once, twice, or three times a week, 
with the subsequent use of bitter tonics, will readily effect. a 
cure. An emetic may be used occasionally in cases of tor- 
por of the stomach, and usually gives marked relief and facil- 
itates the action of other medicines. There are also some 
cases of irritation, the system being sluggish, in which it 
may be resorted to. 

In cases of atony of the stomach, whether accompanied by 
increased secretion of mucus or not, the extract of Nux Vomica 
or Strychnia is used with the greatest advantage ; the first may 
be used in doses of one-eighth of a grain ; the last in doses of 
one-sixtieth to one-twentieth of a grain. I frequently asso- 
ciate the E"ux Vomica with Hydrastin in the form of a pill, 
adding a small portion of Podophyllin, which increases its 



Dyspepsia. 239 

efficacy. The Strychnia is best given in solution, which is 
rendered more pleasant by the addition of a few drops of 
Muriatic Acid. As a common tonic I have found none better 
than, #, Hydrastis, 3ss; Tincture of Xanthoxylum, 3ij ; Water, 
3vj ; M., and give in tablespoonful doses three times a day. 
In these cases counter-irritation is useless, except in those rare 
ones in which the secretion of mucus is excessive. In the 
case last named, the Oxide of Zinc is a very efficient agent, as 
is also the Oxide of Silver. If in these cases there is foefcor of 
the breath, with tenderness of the mouth and gums, the Chlorate 
of Potash may be used with advantage. The administration 
of laxative doses of Podophyllin and Leptandrin, guarded by 
Extract of Hyoscyamus or Extract of Cannabis, is very neces- 
sary, as is also the daily use of the alkaline bath with brisk 
friction. 

The next class of cases are difficult of diagnosis and hard to 
cure, but we may with care determine with considerable accu- 
racy their condition. The restoration of all the secretions is 
of great importance, hence we employ the bath with friction 
thoroughly, and restore a normal action of the bowels by 
laxatives held in suspension with Mucilage or Oil. I have used 
the Podophyllin triturated thoroughly in Salad Oil, and with 
Ulmus or Gum Arabic, or it may be formed into a pill with 
Aloes, coated with Gelatin, and sugar-coated if desired. Small 
doses of Tincture of Yeratrum and Belladonna will be found 
useful in some cases, as will also the Gelseminum. 

Pyrosis is controlled by the use of Sub-nitrate of Bismuth 
with bitter tonics, and the employment of counter-irritation. 
Some of the vegetable alteratives have a marked action in the 
confirmed cases, as the Alnus, Scrophularia, Trillium and 
Ptelea. I have used a pill of #, Extract of Nux Vomica, gr. 
iij; Extract of Ptelea, 3ss; Hydrastin, gr. xv; M., and make 
thirty pills, and give one three or four times a day. Increased 
acridity depends upon irritation of the stomach, which is best 
relieved by the use of the irritating plaster and the administra- 
tion of an infusion of Peach bark. Occasionally we find that 
imperfect digestion is caused by the taking of fluids too freely 
during and after a meal, the gastric juice being too greatly 
diluted. In such case, all fluids at this time should be pro- 
scribed and food taken in a solid form as much as possible. 
Acidity of the stomach and heartburn is sometimes relieved 
by the use of vegetable acids. 



240 The Eclectic Practice of Medicine. 

If the gastric juice is deficient, we may increase it by strict 
attention to the general health, a restricted diet, and the use 
of bitter tonics and gentle stimulants. It may be deficient, on 
account of a want of the necessary fluid, and in such case, a 
glass of cold water taken one or two hours after eating will 
give relief. The employment of a small portion of Muriatic 
Acid, largely diluted, is sometimes attended with advantage. 
Irregularity of the secretion is remedied by the use of bitter 
tonics and the means named to relieve irritation. 

Impaired action of the muscular coat demands the use of 
bitter tonics and Iron, with the IsTux Vomica or Strychnia. If 
connected with constipation, as is frequently the case, we 
associate small portions of Podophyllin with it. Too great 
activity should be treated with narcotics and sedatives, and 
the use of Dioscorin and sometimes Bismuth. 

"When there is evident lesion of the blood it is necessary to 
promote secretion from all the excretory outlets. For this 
purpose a careful selection of vegetable alteratives, possessing 
tonic and stimulant properties will be better than any other 
remedies. The Compound .Tincture of Coryclalis with an 
alkaline diuretic, as the Acetate or Citrate of Potassa, will 
be found effective. Failure of the kidneys to properly elimi- 
nate nitrogenized material from the blood may be treated in 
the manner hereafter named when speaking of the diseases of 
those organs. 

As regards the derangement of innervation we use excitants 
if defective, and sedatives, narcotics and counter-irritants if 
excessive. If there is irritation of the dorsal spinal cord, 
marked benefit results from the continued use of a counter- 
irritant to the part. In other respects we would treat it on 
the principles already laid down. 

In cases in which there is tendency to putrefactive decompo- 
sition, or unnatural fermentation, it is very necessary that the 
patient restrict himself to scant diet, and one easily digested ; 
if this is not done it will be impossible to restore natural 
tone to the stomach. To correct this for the time being, the 
Hyposulphite of Soda, Charcoal and Creosote, have been 
recommended; the first as especially applicable in sarcina. 



Acute Hepatitis. 241 



ACUTE HEPATITIS. 



Inflammation of the liver is a disease of rare occurrence, 
more so, possibly, than of any part of the digestive apparatus. 
It is either acute or phlegmonous, with tendency to terminate 
in suppuration ; or sub-acute, giving rise to functional derange- 
ment, and if continued to effusion of plastic lymph and cirrhosis, 
or to a condition of chronic enlargement. The causes of hepatitis 
are those that would give rise to an inflammation of any other 
portion of the body. 

Symptoms. — Acute inflammation usually affects hut a small 
portion of the organ, and the local symptoms will depend 
somewhat upon its location. The disease usually commences 
with a well-marked chill or rigor, attended by nausea and 
vomiting, frequently of biliary matter. At this time there 
is a feeling of tension and oppression in the hypochondria, 
especially the right, and in the epigastrium; and frequently 
with the vomiting there is a desire to go to stool, but with- 
out the power. Marked febrile reaction follows the chill, a 
hot, dry skin, hard and frequent pulse, tongue coated a dirty- 
yellow, patient dull and torpid, and complaining of an intense 
aching across the temples, bowels constipated, urine scanty and 
sometimes discolored with bile pigment. 

• The fever is always remittent, though sometimes the remis- 
sions are not well marked ; they occur usually in the morning. 
These symptoms continuing, we find but little change, only 
that the patient grows more feeble, the fever assuming a 
typhoid type, with a dark tongue, unless from the situation of 
the inflammation other parts become involved. Thus, if the 
portion next to the diaphragm is involved, an irritation of the 
lung is produced, and a more or less severe cough with dys- 
pnoea and expectoration is produced. If of the part contiguous 
to the colon, a dysentery may be excited that greatly increases 
the patient's suffering. 

The inflammation terminates in resolution, in structural 
change induced by effusion of coagulable lymph, or in sup- 
puration. The first usually occurs in from seven to nine days; 
suppuration may occur as early, or may be postponed for two, 
three, or four weeks. The symptoms of suppuration are 
increased prostration, the occurrence of rigors, with hectic 
fevers or night sweats, and a dull, throbbing, tensive pain. 
16 



242 The Eclectic Practice of Medicine. 

These symptoms may continue many days before the pus 
comes to the surface, or is discharged through the other 
organs. "When pus is formed it will point to that part where 
there is least resistance: thus, if situate on the right side, it 
will open through the abdominal wall ; if at the superior surface, 
it will perforate the diaphragm, and be discharged through the 
bronchi ; if of the I6wer surface, it will probably discharge 
into the transverse colon. If there remains anything like 
normal vitality, adhesive inflammation is set up at that part 
where pressure of pus is greatest, coagulable lymph is thrown 
out, and the parts are agglutinated together; if it were not 
for this, the pus would be discharged into the peritoneal cavity. 

In sub-acute inflammation of the liver, the disease appears in a 
similar manner: first, a chill, then febrile reaction, disturbance 
of the stomach, and arrest of secretion. The patient com- 
plains of weight and tension in the right hypochondrium, and 
a feeling of soreness and deep-aching pain; occasionally there 
is marked pain in the side, coming on in stitches, and some 
pain and aching in the shoulder, the dorsal spine, and neck. 
Occasionally the patient becomes jaundiced, when the symp- 
toms become very much aggravated, sometimes assuming a 
low typhoid type. 

Diagnosis. — We diagnose a hepatitis by the febrile action 
and location of pain, and by the marked derangement of the 
digestive apparatus. 

Prognosis. — The prognosis is favorable in all except the 
very acute cases, in which there is danger of suppuration. 
Even in this case the prognosis is not so very unfavorable, as 
many cases recover, though the duration of the disease is 
long, and it may entail subsequent suffering. 

Post-Mortem Examination. — The liver is usually found 
enlarged, and occupying much more space under the ribs, the 
diaphragm being carried up. It contains a greater amount of 
blood, and is redder in color, or mottled. Lymph may be 
deposited in various parts, and more or less organized. Some- 
times softening results, and we find the liver friable and easily 
torn, and its capsule easily separated. If there has been sup- 
puration, we have the evidence of it in the presence of an 
abscess, or in the presence of small, purulent collections dis- 
tributed through its texture, interstitial suppuration. 

Treatment. — The treatment of hepatitis will not vary mate- 
rially from that proper for other inflammations. The first 



Chronic Hepatitis. 243 

object is to place the stomach in such condition that remedies 
may be kindly received and appropriated. If there is nausea 
and vomiting, there is little use to temporize with it; a thor- 
ough emetic will relieve this, and also modify the fever. 
Whether this is given or not, the patient should be put upon 
the use of the special sedatives, with a diaphoretic, as: R-, 
Tincture of Veratrum, Tincture of Aconite, aa, gtt. xx; Tinc- 
ture of Asclepias, f3j; Simple Syrup, 5ij; M.; of which a tea- 
spoonful may be taken every hour. A mild cathartic of Podo- 
phyllin, Jalap, and Extract of Iiyoscyamus, followed by an 
infusion of Dioscorea, is of advantage. If nausea continues 
after the use of the emetic, or if an emetic is not deemed 
desirable, an infusion of the Compound Powder of Rhubarb 
and Potassa, or of Peach-tree Bark, may be used, or the Sub- 
nitrate of Bismuth and Morphia. 

If the inflammation is acute, or in either case, the applica- 
tion of cups, with or without scarifying, gives speedy relief 
from pain. These should be followed by hot fomentations of 
Hops, Stramonium, etc., or in some cases, where heat increases 
the suffering, by the cold water bandages. 

Small doses of Leptandrin, with diaphoretic powder, may 
be continued throuo-hout the treatment, as tending to relieve 
the congested condition of the viscus, and at the same time 
being unirritating. The fever being controlled within the first 
day or two by the sedatives, and the remission lengthened, as 
it will be, Quinia should be administered pretty freely (from 
ten to fifteen grains during the remission), with the effect of 
materially modifying the fever and inflammation. This treat- 
ment judiciously pursued, will effect resolution, in a large 
majority of cases, in from seven to nine days, and sometimes 
much sooner. 



CHROMIC HEPATITIS. 

Chronic inflammation of the liver was a very frequent com- 
plaint some years since, if we are to believe the history given 
us, and we have no reason to doubt it, as the continued admin- 
istration of Me*rcury, for every disease, unduly stimulating 
this organ, might well produce this result. Since Mercury 
has gone out of date to such an extent we see but few cases, 
and these among persons above middle age, and who have 
been mercurialized according to the old formula. do not 



244 The Eclectic Practice of Medicine. 

deny that the disease might arise from other causes, like other 
chronic inflammations, but they are the fewest cases. 

Symptoms. — The symptoms met with in this disease are in 
part owing to the affection of the liver, and in part owing to 
sympathetic derangement of other organs. As illustrating 
the disease as described a score of years since, I will quote 
from Copland: "As chronic disease of the substance of the 
liver may present every grade, down from the acute state to 
the slightest deviation from the healthy function, so the symp- 
toms attending it must vary, and assume more or less precise 
characters. In the slighter or more obscure forms, the nature 
of the disease is seldom evinced by distinct phenomena: vari- 
ous dyspeptic symptoms, flatulency, acid or acrid eructations; 
sometimes nausea, and less- frequently vomiting; loss of flesh; 
muddy or sallow complexion; dry cough or embarrassed 
respiration, torpid state of the bowels; aching or pain in the 
back, or in the right hypochonclrium, or a sense of weight and 
tenderness in the region of the liver; an irregular state of the 
bowels, or dark-colored, offensive, slimy, greenish, or watery, 
or muddy evacuations; dark or saffron color of the urine; 
slight acceleration of the pulse in the evening; increased heat 
and restlessness in the night; heat of the palms of the hands 
and soles of the feet in the evening, and chilliness in the 
morning; white, foul or rough tongue; bitter taste in the 
mouth; sickly or yellowish hue of the countenance; depres- 
sion of spirits; and in some cases elevation of the shoulders, 
are the chief symptoms of hepatitis." In the very severe 
cases, the general symptoms may not be any more severe, but 
there is marked local evidence of serious disease. 

The above symptoms are drawn to the life, as the disease 
was formerly viewed, and it will be easily perceived that the 
diagnosis of liver complaint could be made in every case of 
chronic disease, and the only difficulty would be to find any- 
thing else to treat. 

Diagnosis. — We will diagnose a chronic inflammation of the 
liver by the feeling of weight and tension, and dull pain in 
the right hypochondrium, and by the evidence of change of 
its secretion, in bilious diarrhoea, in its being thrown into the 
stomach, in its appearance as jaundice, or in the urine. 

Prognosis. — Chronic hepatitis can be readily cured, unless 
the inflammation has passed on to structural change, or 
resulted in degeneration. 



Chronic Hepatitis. 245 

Post-Mortem Examination. — The liver is found in various 
conditions: at times large, soft, friable, and discolored; again, 
hard, contracted, and blanched. The morbid changes in the 
majority of cases, will range themselves under one of the two 
heads, hypertrophy or atrophy, as the symptoms during life 
iudicated hypersecretion, or want of secretion. Atrophy of 
the liver is by far of most frequent occurrence, and is almost 
always attended by structural change. In some cases there is 
induration, the degree of density varying from that of the 
organ normally to almost a cartilaginous condition. The cir- 
rhosis of Laennec is the last and severest form, the entire 
organ becoming wrinkled and shriveled, diminished to one- 
half its natural bulk, and of a yellowish or greenish-brown 
color. 

Treatment. — A gentle excitant to the liver and bowels will 
take a prominent place in the treatment of the milder cases. 
This we might obtain from the Compound Tincture of Cory- 
dalis, already named, or from, #, Essl. Tincture of Podophyl- 
lum, 3ss; Essl. Tincture of Leptandra, Sj ; Essl. Tincture of 
Hydrastis, 3ij ; Neutralizing Cordial, 3iv; M.; in doses of 
a teaspoonful three, four, or five times a day; or an infu- 
sion of equal parts of Leptandra and Dioscorea has proven 
advantageous; or the Podophyllin pill, to keep the bowels 
open, will answer the purpose. If there is tendency to irrita- 
tion of the stomach, the Peach-bark tea is an admirable 
remed}^: or the Hydrocyanic Acid may be used. Alkaline 
diuretics, as the Acetate or Citrate of Potassa, are important 
parts of the treatment. I usually administer them with the 
Carbonate of Ammonia, or Chlorate of Potassa, in doses suf- 
ficient to keep the urinary secretion free. 

The daily use of the bath, with brisk friction, should always 
be recommended, as it relieves irritation of the nervous sys- 
tem, and also acts as a derivaut. The most important meas- 
ure is the use of counter-irritants, without which we can not 
succeed in many cases. The irritating plaster is preferable to 
any other means, and should be continued as heretofore 
recommended, until the soreness, weight, and tension has 
entirely disappeared. 

A bracing tonic treatment, with a moderate quantity of 
stimulants, aid in establishing health after the severer symp- 
toms have passed off. The Iodine pill, heretofore named (#, 
Iodine, Extract of ISTux Vomica, aa, gr. v; Hydrastin, 3ss; 



246 The Eclectic Pkactice of Medicine. 

Extract of Taraxicum, q. s.; M.,.and make thirty pills), some- 
times answers an admirable purpose, in doses of one pill three 
or four times a day. 



FUKCTIOISrAL DISEASES OF THE LIVER. 

No function is so obscure as that of the liver, and yet none 
have been so patiently investigated; something, it is true, has 
been gained; we can determine accurately the constituents of 
bile, what it is formed from, when it is formed, and the con- 
ditions necessary to its elaboration; and yet we have no posi- 
tive knowledge of what becomes of it, or of its use in the 
economy. This being the case, it is no wonder that the dis- 
eases of function are obscure; and being thus obscure, and 
investigated with difficulty, that ignorance should continually 
prate about disease of the liver, liver complaint, etc., connect 
it with every other affection, and adopt a treatment which, 
being applicable to this, was applicable to all diseases, as this 
formed a part of them. I well recollect the studied care with 
which the professors in regular colleges, some years ago, would 
undertake to prove the liver the seat or cause of all disease, 
and with what enthusiasm they would point to the remedy. 

According to the best authority, we may consider the bile, 
first, as an excretion, which, if not removed from the blood, 
will give rise to^i class of symptoms termed jaundice, and if 
continued for any considerable length of time will arrest the 
processes of life; second, as having some special function to 
perform in the act of digestion, so that if arrested or changed 
materially in quality, this function is impaired or entirely 
arrested; lastly, that it furnishes some material to the blood 
by absorption from the alimentary canal, which is essential to 
its normal condition. It will thus be seen that much derange- 
ment of function will be followed by severe derangement of 
the system; but fortunately these changes are of very unfre- 
quent occurrence, instead of being the most frequent, as form- 
erly supposed. 

Excessive Action. 

Hypersecretion of bile occurs occasionally as the result of 
irritation and congestion of blood. The bile being irritant to 
the intestinal canal, gives rise to increased peristaltic action 
and diarrhoea. It is termed bilious from its color, yellowish- 
brown or green, and from the fact that an excess of bile may be 



Deficient Action of the Liver. 247 

found in the faeces by analysis. An inverted peristaltic action 
may take place, the bile being thrown from the duodenum into 
the stomach, giving rise to nausea and vomiting, and being 
ejected by the mouth; this is attended by diarrhoea, and has 
sometimes been called bilious cholera. Bilious diarrhoea is 
attended with considerable pain of a twisting, griping charac- 
ter, with a feeling of soreness in the bowels ; occasionally there 
is considerable febrile action, with dry skin and scanty secretion 
of urine. In some cases, the patient complains of pain in the 
right side and shoulder, with a feeling of tension and fullness 
in the right hypochondrium, and possibly enlargement of the 
liver. This excessive action may occur frequently as in cases 
of disease of the stomach, or it may occur but once. 

Treatment. — If there is considerable irritation of the intesti- 
nal canal, with small, griping evacuations, a dose of the Com- 
pound Powder of Jalap and Senna, to thoroughly evacuate the 
bowels, will prepare the way for other medicine. This may 
be followed by Dioscorin, gr. vj; Opium, gr. iij ; made into 
six powders and given every three hours. If the diarrhoea still 
continues after this, the Sub-nitrate of Bismuth in doses of five 
grains, may be added, or the more common astringents used. 
If there is a dry skin, with some febrile action, the hot Mus- 
tard foot bath, with the Compound Tincture of Serpentaria, 
may be used until perspiration is induced. If there is nausea 
and irritation of the stomach, an infusion of the Compound 
Powder of Rhubarb may be used as the vehicle for the medi- 
cines heretofore named. 

Counter-irritation over the right hypochondrium should be 
employed, if there is soreness, and in the more severe cases, 
followed by hot fomentations to the side and over the abdomen- 
If there still remains a feeling of languor, with dry and con- 
stricted skin, hard pulse, headache, with coated tongue and dry 
or clammy mouth, the Acetate of Potassa, in doses of 3ss three 
or four times a day, with equal parts of Quinia and Hydras- 
tin, in doses of five grains two or three times a day, will 
complete the cure. 

Deficient Action. 
Torpor of the liver is of more frequent occurrence than any 
other functional derangement, and is probably due in a major- 
ity of cases to diseases of adjacent parts of the intestinal 
canal. It is frequently associated with dyspepsia, and hence 



48 The Eclectic Practice of Medicine. 

the prominent symptoms named under that head, were for- 
merly considered to indicate torpor of the liver. 

Thus, Copland, speaking of this derangement, says : "When 
the patient complains — after having ei .joyed good health, or 
without having experienced on former occasions, either acute 
or chronic affections of the liver or stomach, or other severe 
disease likely to implicate the organ — of dyspeptic symptoms, 
with a costive or irregular state of the howels, the stools being 
pale or clayey, and the urine dark or high-colored, or thick 
after having cooled ; of want of appetite, drowsiness or pain 
over the eyebrows, lowness of spirits or hypochondriacal 
feelings ; of flatulency of the stomach and bowels, a foul and 
loaded tongue, and a bitter and disagreeable taste in the 
mouth, particularly in the morning and of a sallow, dark and 
muddy appearance of the countenance or skin, but without 
any pain, febrile movement toward night, or thirst, or chills 
followed by heat, or hardness of the pulse, or fullness or ten- 
derness in the region of the liver, it may be reasonably 
inferred that the functions of the liver are simply impaired." 

Congestion of the liver will in most cases give rise to 
deficient action, and this may be usually determined by the 
fullness or tension in the right hypochondrium, especially if it 
has followed dissipation. We may recognize two causes, the 
one just named, and a simple depression or exhausted state 
of the vital energy of the organ, generally owing as above 
mentioned to disorder of adjacent parts. The symptoms 
given will embrace all cases, and though not all dependent 
upon the torpor of the liver, they are frequently associated 
with it. 

Treatment. — When the torpidity is of recent occurrence 
there is but little difficulty in treatment. A mild cathartic 
of Podophyllin and Leptandrin, with the Extract of Hyoscy- 
amus, given in small doses so as to produce one or two evacu- 
ations daily, is useful in all cases. Or, if the patient is stout 
and rugged, and the disease sudden in its appearance, they 
may be applied to produce a marked effect. These remedies 
may be used, lessening the dose daily, until the bowels become 
regular. The appetite may be improved as well as the inner- 
vation of the bowels and liver, by the administration of #, 
Extract of Nux Vomica, gr. iv ; Hydrastin, 3ss ; Extract of 
Leptandrin, q. s.; M., and make thirty pills, of which one may 
be taken three or four times daily. If the skin is dry and 



Neuralgia of the Liver. 249 

harsh, we obtain great benefit from tbe use of #, Essl. Tinc- 
ture Asclepias, Essl. Tincture of Dioscorea, aa, 3ss ; Hydro- 
chlorate of Ammonia, 3j ; Simple Syrup, 3ij ; M. ; in doses of a 
teaspoonful every three or four hours ; or #, Comp., Tincture 
of Corydalis, Gin Bitters, in equal parts, in doses of a table- 
spoonful four times a day, with 3j of Acetate of Potash in the 
twenty-four hours. 

If the torpidity does not yield readily, Sulphate of Quinia, 
associated with Hydrastin, in doses of ten or twelve grains 
daily, will be found advantageous ; and if there seems to be a 
demand for Iron, the Prussiate may be added to the compound. 
The trunk should be sponged with salt water daily, and the 
bowels rubbed thoroughly, and occasionally if there seems to 
be undue tension and rigidity of the abdominal muscles, the 
wet bandage may be applied on going to bed at night. 

Neuralgia of the Liver. 

Neuralgia of the liver occurs occasionally in persons of a 
nervous habit, and who have had neuralgia in other parts 
of the body, or derangement of some of the abdominal vis- 
cera. It is most frequently produced by cold, fatigue, or 
over-excitement. 

Symptoms. — The pain usually comes on suddenly, and is 
intense in its character; sometimes the patients describe it 
at first, as being a stitch in the side, preventing their straight- 
ening up; being easier in a few minutes, they would flatter 
themselves that it had disappeared, but it would return again 
with more intensity, sometimes becoming almost unbearable. 
Some persons are so subject to it, that they can not undergo 
active exertion without bringing back the pain. In the severer 
cases, it continues for hours, the epigastrium and abdomen be- 
coming tender, and the pain frequently passing to the right 
shoulder and spine. 

Treatment. — The immediate treatment for a severe attack 
would consist in the application of a sinapism followed by hot 
fomentations, the Mustard foot bath, and internal administra- 
tion of five-grain doses of Diaphoretic powder as often as 
seemed necessary. The pill of Podophyllin and Hyoscyamus, 
heretofore named, might be given to produce an action of the 
bowels. For its permanent removal, a tonic treatment should 
be adopted, especial attention being paid to overcoming con- 
stipation and irregularity of the bowels. 



250 The Eclectic Practice oe Medicine. 

Gall Stones. 

Gall stones are sometimes formed of inspissated bile in the 
ducts of the liver, or in the gall-bladder, but most generally 
of cholesterine, mixed with the coloring material of the bile. 
The causes of these formations are, to some extent, doubtless, 
to be found in the constitution of the bile, but in the case of 
cholesterine stones, principally to disease of the coats of the 
gall-bladder. 

These concretions vary in size from a small pea to a mass 
as large as a hen's egg, or even larger. They are found in 
the gall-bladder, or in the ductus choledochus, and also in 
the intestinal canal, being sometimes round, but more fre- 
quently oval in form. They are only found in persons under 
middle age, and are said to be more frequent in women than 
in men. Among the predispositions to their formation may 
be named sedentary occupations, and close confinement, and 
associated to fatty degeneration of structure, and frequently 
to lithic acid deposits in the urine. 

Gall-stones may remain within the gall-bladder for a long 
time without giving rise to any symptoms that may be noticed. 
If it produce inflammation and ulceration, the symptoms would 
be observed. It may pass down and close the cystic duct, giv- 
ing rise to disorder of digestion, caused by loss of this recep- 
tacle of bile. It may pass into the common duct, and lodg- 
ing give rise to jaundice, by obstruction. Lastly, they may 
pass through the ductus comnmnus into the duodenum, and 
be discharged with the faeces. 

"The symptoms of the passing of gall-stones generally come 
on suddenly, two or three hours after eating, with severe pain, 
like that of colic, in the region of the gall-bladder. The pain 
is not equal. There is constant, dull, aching pain, which is 
every now and then interrupted by a paroxysm so excruciat- 
ing that the patient bends himself double, or rolls about the 
floor, at the same time pressing his hands firmly against the 
pit of the stomach, which sometimes eases the pain. These 
severe proxysms produce great exhaustion ; the pulse become 
slow and weak, the face pallid, and the whole body is covered 
with a cold sweat. Together with these symptoms, there is 
distressing nausea and frequent vomiting. The matters vom- 
ited are very acid, and in cases of repeated vomiting, while 
the common duct is not closed, are bitter." — (Bucld.) 



Gall Stones. 251 

The attack lasts a variable length of time, sometimes but a 
few moments, at others hours, and again, in rare cases, for 
several days, depending upon the number and size of the calculi 
that pass. When the attack is greatly protracted, and 
more than one passes through the duct, there is an interval of 
ease between; if continued long, symptoms of jaundice, with 
marked prostration, make their appearance, and there is 
severe derangement of other functions. In some persons these 
attacks occur at longer or shorter intervals for years. 

Though excessively painful, the danger is not usually great. 
When a fatal termination results, it is caused by impaction of 
the calculus in the common duct, or by exciting inflammation 
or closure of the duct, and in rare cases by causing obstruction 
of the bowels and fatal ileus. 

Treatment. — Various means of treatment have been pro- 
posed to facilitate and hasten the passage of these concretions. 
Some recommend the use of an emetic, which will answer a 
good purpose if given in nauseating doses until the system is 
completely relaxed, and then carried to free emesis, large quan- 
tities of warm water being taken to favor its action. Dr. Prout 
recommended the giving of large draughts of hot water con- 
taining Carbonate of Soda in solution, in the proportion of one 
or two drachms to the pint. It was urged that the alkali 
counteracted the acidity of the stomach and thus relieved some 
of the most distressing symptoms, and acted as a fomentation 
to the part. Full doses of Opium have been given with 
advantage for the relief of the pain ; it has been best used with 
Hydrocyanic Acid, which relieving irritation of the stomach, 
enabled the Opium to be retained. 

As a local application the hot fomentations of Hops, Stra- 
monium or Poppy- heads, will often relieve the suffering. 
They should be applied as hot as can be borne, and fre- 
quently renewed. If they fail of giving relief, we may resort 
to the application of cold, as a towel wrung out of ice- 
water, or pounded ice in a bladder. Sometimes the local 
application of the Tincture of Aconite with Chloroform gives 
relief. 

If these measures fail, the vapor bath, or alcoholic vapor 
bath may be used, with the free employment of an infusion of 
equal parts of Dioscorea and Verbascum, or either of the 
agents. These means should be carried to the production of 
copious diaphoresis and complete relaxation. As a last resort, 



252 The Eclectic Practice of Medicine. 

and a most efficient one, use Chloroform as an anaesthetic to 
such an extent as to control the pain. 

The pain ceasing for some time leading to the inference that it 
had passed into the intestine, a mild cathartic of Compound 
Powder of Jalap and Senna, with copious injections of warm 
water, should be used to hasten its removal, and the discharge 
of the accumulated bile. Afterwards, small doses of Leptan- 
drin and Dioscorin, with Hydrastin, will be sufficient in 
most cases to remove the condition upon which their forma- 
tion depends. Various remedies have been proposed as a sol- 
vent of gall-stones in the bladder, but with very little or no 
success ; the one most relied on, was a mixture of three parts 
of Sulphuric ^Ether with two of Essence of Turpentine ; this 
was very extensively used at one time, but very seldom latterly. 



JAUNDICE. 

Jaundice should be considered as only a symptom, and may 
occur in most affections of the liver. It consists of the reten- 
tion and absorption of the coloring matters of the bile, and 
their deposit in various structures, principally the skin and 
conjunctiva; occasionally it is deposited in the deeper struc- 
tures, as of the eye, giving rise to yellow vision ; in the nails, 
and in internal organs. It is supposed to arise in two ways: 
1st, by some impediment to the free passage of bile from the 
lobules where it is secreted to the duodenum, and its conse- 
quent absorption ; and 2d, by defective action on the part of 
the liver, the materials of the bile not being removed from the 
blood. 

"We may classify the causes of jaundice as follows: a, from 
hypersecretion of bile ; b, from congestion of the liver and por- 
tal system, c, from chronic alterations of the structure of the 
liver, preventing secretion or the free discharge of bile; d, 
from spasm or temporary obstruction of the biliary ducts ; e, 
from obliteration or compression of the biliary ducts or gall- 
bladder; and lastly, from disease of the duodenum, partially 
or entirely occluding the ductus communis. 

Symptoms. — The symptoms of jaundice vary very greatly, 
depending upon the course, the extent of disease of the liver, 
and its complications. Usually, there is disturbance of the 
bowels, colicky pains, constipation, the faeces being clayey, pale, 



Jaundice. 253 

and scanty. The mouth is dry, has a bad taste, tongue coated, 
and sometimes nausea and pain in the head. The yellow tinge 
usually makes its appearance in the eyes, and gradually extends 
to all parts of the body, the color being deepest in the folds and 
wrinkles of the skin. Usually the skin is harsh and dry, and 
the urine high-colored, at first yellowish, but afterward saffron- 
colored, frequently coloring the clothing that it comes in con- 
tact with. "The patient generally complains of a severe, 
heavy, or lancinating headache, with a sense of heat, particu- 
larly in the forehead ; and he frequently falls into a state of 
despondency or melancholy, or becomes morose. There is 
sometimes lethargy and frequent watchfulness. The tongue 
and palate are coated with a yellowish sordes, and a bitter 
taste is felt in the mouth. The appetite is extremely irregu- 
lar, sometimes being entirely lost, at other times ravenous. 
Thirst is usually present. Fain, weight, or a dragging sensa- 
tion and tenderness, are often felt at the epigastrium; fre- 
quently with flatulence and eructations, nausea, difficult or 
painful digestion, and vomiting of a bitter, acrid and somewhat 
dark fluid. In some cases acute pain rises in the course of the 
common duct, and increases as it reaches the epigastrium, 
with more or less uneasiness in the region of the liver and top 
of the right shoulder, or beneath the right scapula, or between 
the shoulders." — (Copland.) 

In some cases febrile action is a marked feature of the affec- 
tion, the fever being remittent or intermittent in its char- 
acter, and attended with weight and tenderness in the right 
side, and marked derangement of the digestive functions; 
these cases are generally acute. In others it comes on slowly, 
with symptoms of marked cachexia and prostration. The 
skin changes its color very gradually, but at last, after weeks, 
or sometimes months, becomes of a yellowish-green or bronze 
color; in this case the disease will be found to depend on seri- 
ous structural lesion of the liver. In others, the symptoms are 
developed with rapidity; the skin becomes intensely yellow, 
or yellowish-green ; there is great prostration of strength, lan- 
guor, bitterness, great depression of the nervous system, and 
finally delirium or coma, the disease frequently terminating 
fatally. Or it may come on very slowly, the skin gradually 
gaining a dull-yellowish tinge, the symptoms being those 
described under the head of deficient secretion or torpor of the 



254 The Eclectic Practice of Medicine. 

liver; in this case, the jaundice is from retention of the mate- 
rials of the bile in the blood. 

Diagnosis. — It is very easy to recognize jaundice, the pecu- 
liar appearance of the patient telling the story at the first 
glance; but it is a difficult matter to determine the condition 
upon which it is dependent. 

Prognosis. — The prognosis should be favorable in those 
cases in which it is not dependent upon structural disease 
of the liver. If caused by this, it will depend upon the 
character of the disease, and the prospect of its removal. 

Post-Mortem Examination. — In some cases, no apparent 
lesion can be found to account for the death or the jaundice. 
In others, the liver will be found variously changed: conges- 
tion, inflammation, suppuration, atrophy, cirrhosis, closure of 
the gall-ducts, presence of gall-stones, hydatids, malignant 
disease, etc., will account for the symptoms. 

Treatment. — The treatment of this affection will have to be 
varied, and adapted to the disease or condition of the system 
giving rise to it. It is generally supposed that all that is 
necessary is to give some medicine that will act on the liver, 
and increase the secretion of bile; and for this purpose our 
old-school friends give Mercury, the new-school Podophllyin — 
and in many cases to the detriment of the patient. 

If there is a feeling of fullness in the region of the liver, 
with tenderness on pressure under the false ribs and epigas- 
trium, with some febrile action, I should order cups to the 
side, followed by hot fomentations if the disease was acute, 
and the irritating plaster if chronic ; the warm or spirit vapor 
bath may be used in acute cases. To favor diaphoresis, an 
infusion of Asclepias and Dioscorea, with the Diaphoretic 
powder may be employed ; and to act on the bowels, equal 
parts of Compound Powder of Jalap and Bi-tartrate of Potassa. 
This may be followed by a solution of Acetate of Potassa, and 
small doses of Podophllyin and Leptandrin, as, #, Podophyllin, 
Leptandrin, aa, gr. ij; Lactin, $j; triturate thoroughly, and 
divide into twenty powders, of which one may be given every 
three or four hours. If there is continued tendency to fever, 
with arrest of secretion, Quinia and Hydrastin may be used as 
heretofore recommended. 

If the disease comes on slowly, and has lasted for some 
time, the vegetable alteratives, with saline diuretics, the 



Acute Enteritis. 255 

judicious use of tonics, and the thorough use of the bath, 
will be the principal means. -If there should be tenderness 
on pressure over the liver, the irritating plaster will materially 
aid the treatment. Being satisfied that there is no structural 
lesion, making it impossible for the liver to respond to the 
action of remedies, we may employ small doses of Podophyllin 
as above named. In these cases, I have used the Essl. Tinct. 
of Leptandra and Dioscorea with the Compound Syrup of 
Rhubarb and Potassa, also the !N"ux Vomica with Hydrastin 
as heretofore named. 

If from exuberant secretion of bile, as evidenced by bile in 
the feces, and sometimes by bilious diarrhoea, the administra- 
tion of Leptandrin, Dioscorin and Opium, with cups to the 
side, will be appropriate. If from congestion of the portal 
circle, manifested by bloated countenance, livid lips and 
absence of bile in the feces, the treatment should be com- 
menced with a saline purgative, the use of the hot foot bath, 
and other means to determine to the skin, and saline diuretics. 
These means may be followed by agents that act directly on 
the liver, as the Leptandrin and Podophyllin. The Chlorate 
of Potassa with Extract of Conium sometimes answers an 
admirable purpose. 

If there is manifestly torpor of the liver, the jaundice 
being slight, the common Comp. Podophyllin Pill may be 
used, and frequently with the result of speedily removing the 
difficulty. When the cause is obscure, the indications should 
be met as they arise, all harsh and debilitating measures being 
studiously avoided. The diet should be bland and easily 
digested, the bowels kept soluble by an occasional laxative^ 
pill; the daily bath, with brisk friction employed; and care 
used to keep the kidneys acting normally. Much may be 
accomplished in this way, while if harsh measures were 
adopted, the case might speedily terminate fatally. 



ACUTE ENTERITIS. 
By this I intend to designate an acute inflammation of all 
the coats of the small intestine, in contra-distinction to muco- 
enteritis, or an inflammation confined to the mucous coat. 
Fortunately it is not of very frequent occurrence, as it is 
one of the severest and most fatal diseases of the intestinal 



256 The Eclectic Practice of Medicine. 

canal. It may be caused by cold, by irritating articles of food, 
or follow other affections of the bowels. 

Symptoms. — In some cases it may be preceded by irritation 
of the intestinal canal and diarrhoea, but usually it manifests 
itself first as a soreness and tenderness about the umbilicus, 
with constipation. Chills or rigor3 soon make their appear- 
ance, followed by slight febrile reaction ; they may continue 
thus for two or three days, or the first chill may be followed 
by a remittent or continued fever. Sometimes the fever runs 
high for the first day or two, but passes into exhaustion with 
great rapidity. The pain and tenderness felt at the beginning, 
are now very severe, the patient can bear no pressure over the 
abdomen, which is much distended. The abdominal walls 
are hard, and sometimes seem knotted; and the patient lies 
upon the back, and draws the feet upward to take off their 
tension. The patient feels as if the bowels should be moved, 
and not unfrequently insists on trying to evacuate them, the 
straining greatly increasing his sufferings. The constipation 
is obstinate, and is usually increased, and irritability of the 
stomach and vomiting excited, by the injudicious use of 
cathartics in the early stage of the affection. As the disease 
advances to a fatal termination, the pulse becomes thready 
and weak, respiration quick and anxious, the tongue coated a 
dirty-brown, with sordesonthe teeth, the bowels much swollen 
and exquisitely tender except shortly previous to death, when 
all sensibility disappears, and the patient's mind wanders or is 
sometimes perfectly clear, hoping for relief even to the last. 

Diagnosis. — We will diagnose this affection from bilious or 
lead colic, or intussusseption, by the rigors, active febrile 
action, and evidences of inflammation upon examining the 
abdomen. From muco-enteritis it may be determined by the 
obstinate constipation. A careful examination should be made 
to determine that the symptoms are not the result of hernia. 

Prognosis. — Though a very serious disease, we may expect 
to save a considerable proportion of our patients, if is prop- 
erly diagnosed at the commencement. If, however, cathartics 
have been freely employed in the early stage of the affection, 
the prospect is not very flattering. 

Post-Mortem Examination. — The entire thickness of the 
intestine is usually found to present evidences of inflamma- 
tion, or determination of blood. There is more or less effu- 
sion under the peritoneal coat, and sometimes from its free 



Muco-Entemtis. 257 

surface; occasionally causing adhesions of the intestines to 
the adjacent parts, and in some cases perforating the bowels; 
other organs may he incidentally affected. 

Treatment. — Under no circumstances should an active or, 
indeed, any cathartic he given until the more active symptoms 
have been removed. We direct at first, cups and scarification 
around the umbilicus, followed by hot fomentations to the 
entire abdomen, or if unpleasant to the patient, the cold, wet 
bandage. If there is a frequent desire to evacuate the bowels, 
a large enema of warm water, with Conium or Opium, may 
be used with advantage. Opium, in doses of one grain every 
three hours, or sufficiently often to control the pain, should be 
employed, and the special sedatives in the usual doses to 
relieve the fever. A solution of the Chlorate of Potassa with 
the Extract of Conium is highly recommended to assist in 
overcoming the contraction of the intestine; I would prefer, 
however, the free use of Dioscorea or Epilobium as agents 
better calculated to fulfill the indications. 

If there is nausea, it may be treated with small doses of the 
Compound Powder of Phubarb in infusion, or an infusion of 
the bark of the Peach tree, or Hydrocyanic Acid, and the 
application of a sinapism to the epigastrium. If there is hic- 
cough or singultus, raw Brandy in small quantities will 
answer the purpose. 

Pelief may be sometimes given from the extreme distension 
of the bowels by using copious injections of warm water, with 
the addition of a small portion of Turpentine and Assafoetida; 
if, however, it increases the pain, it should be discontinued. As 
soon as the irritation commences to pass off, the bowels may 
be moved with the Compound Powder of Jalap as an enema, 
and Sweet Oil internally. 

The food should be of the most bland description, and such 
as would leave but little debris. In the severest cases, Milk 
and Limewater will answer the best purpose. The patient 
must lie quiet in bed, in one position, and all causes of excita- 
tion must be carefully avoided. 



MUCO-ENTERITIS. 

Inflammation of the mucous membrane of the intestinal 
canal may result from cold, or from acrid or irritating ingesta. 
17 



258 The Eclectic Practice of Medicine. 

It may be confined to the small intestine, or affect the 
stomach, gastro- enteritis ; or the large intestine, dysenteric- 
diarrhoea. 

Symptoms. — It usually makes its appearance with tenderness 
about the umbilicus, more or less pain, and a desire to evacu- 
ate the bowels frequently. There is diarrhoea, the operations 
being sometimes large, at others small, but never seem suffi- 
cient or gratify the desire. Frequently the patient feels the 
tendency to a motion, but nothing passes, or does not pass 
until they have been to stool sometime. They vary in char- 
acter, being usually yellowish, thin, acrid, and combined with 
more or less mucus. There is more or less constitutional 
disturbance, a harsh, dry skin, scanty secretion of urine, hard 
pulse, and coated tongue. Sometimes there is pain in various 
parts of the body, and marked headache. 

If the stomach is involved, there is nausea with occasional 
vomiting, the stomach being irritable, and frequently rejecting 
all medicines that are given. If the larger intestine is in- 
volved, there are the tormina and tenesmus of dysentery in 
addition to the symptoms of this affection, the stools being 
sometimes diarrhoeal, sometimes dysenteric. If it continues 
for a considerable length of time, ulceration may occur, the 
operations containing pus, and the system very much 
■exhausted. 

Inflammation of the glands of the intestine may occur as a 

primary disorder, exhibiting the following symptoms : "At 

first of slight disorder of the digestive functions, consisting 

chiefly of colicky pains, want of appetite, and relaxation of 

the bowels, ceasing and recurring from time to time. There 

are also borborygma, flatulence, mucous stools, a relish chiefly 

for the more stimulating articles of food, a white or loaded 

tongue, a soft and languid pulse, and a turbid state of the 

urine. In other cases, the symptoms are more severe at the 

(commencement. The appetite is lost, the tongue presents a 

grayish-white or yellowish coating, and is somewhat red at 

its point and edges ; the mouth is clammy, occasionally 

apthous, with an insipid, sickly, nauseous and sour taste ; 

the breath is disagreeable and foetid, and there is tenderness 

upon firm pressure around the bowels." — (Copland.) In the 

more severe cases, there is a low form of fever, with great 

prostration, exhibiting at last all the symptoms of typhoid 

disease, which it may be truly called. 



Muco-Enteritis. 259 

Diagnosis. — We diagnose mucous inflammation of the small 
intestines from simple diarrhoea, by the manifest symptoms 
of constitutional disturbance and inflammation. 

Treatment. — The administration of astringents to check 
the diarrhoea, does not answer well in this case, usually 
increasing its severity. As the diarrhoea is dependent upon 
inflammation, it is evident that this should be first removed. 
For this purpose I am in the habit of recommending the 
warm bath when convenient, the warm foot bath always, 
with the administration of a diaphoretic, as Compound Pow- 
der of Ipecac and Opium, or Tincture of Asclepias with Tinct. 
Opii Camph., or a simple infusion of Pennyroyal. The 
Compound Powder of Rhubarb in infusion, or the Neutral- 
izing, Cordial may be used in doses sufficient to change the 
character of the operations, and then in small doses until the 
discharge ceases. 

The Epilobium will be found a most efficient agent in these 
cases, associated with the means above named. The adminis- 
tration of equal parts of Dioscorin, Leptandrin, and Geraniin, 
in doses of two or three grains, in connection with the special 
sedatives, is very good treatment. If there are griping, colicky 
pains, Salad Oil taken pretty freely to move the bowels, and 
followed by an opiate, answers a very good purpose. The 
White Liquid Physic (#, Sulphate of Soda, gviij ; dissolve in 
Water, Ojss ; and add Mtric and Muriatic Acid, aa, 3j), in 
doses of a tablespoonful every hour, with Simple Syrup, until 
it moves the bowels, and then followed by an opiate, will occa- 
sionally prove useful, especially in cases of irritation of the 
stomach with nausea and vomiting, or when there is tendency 
to dysentery. 

The inflammation having subsided, if diarrhoea still con- 
tinues, we may treat it with astringents, as we would a case 
of simple diarrhoea. If there should be a tendency to chronic 
enteritis, the irritating plaster should be applied to the um- 
bilical region until relief is obtained. If the disease exhibits 
marked evidence of periodicity or the fever should be per- 
sistent, use Quinia in full doses; or if there are gaseous 
accumulations, with foetid eructations and discharges, the 
Chlorate of Potassa, Soda or Lime. 



260 The Eclectic Practice of Medicine. 

CHKOtflC ENTERITIS. 

Chronic inflammation of the small intestines occurs as the 
result of the acute disease, or it may be gradually developed 
during diarrhoea. It constitutes chronic diarrhoea, and may 
occur at all ages and in all climates, but is more frequent in 
Northern persons who have spent the warm season in the South. 
It may extend to the stomach, giving rise to symptoms of 
dyspepsia, or to the large intestine, inducing dysentery. 

Symptoms. — In chronic diarrhoea we find the patient having 
a variable number of fluid or semi-fluid evacuations from the 
bowels in the course of the day. They may or may not be 
attended by colicky pains about the umbilicus, and more or 
less tenesmus. The discharges are of variable color, some- 
times light, at others dark-brown, greenish, yellow or clay- 
colored, watery or pultaceous, containing mucus, pus, shreds 
of lymph, and sometimes blood. Occasionally they are large, 
but most usually of moderate size. The patient is very much 
reduced in flesh, has lost strength and energy; the appetite 
is poor and variable ; the food does not seem to digest well ; 
there is dryness and constriction of the skin, which is yellowish 
or sallow, and seems shriveled, with imperfect action of the 
kidneys. The nervous system is deranged, the patient being 
restless, irritable and nervous, usually not sleeping well at 
night, and troubled with occasional wandering pains and 
headache. Sometimes we find a marked remittent fever with 
it, and m the later stages hectic fever and night sweats. 

Diagnosis. — The diagnosis of chronic enteritis is easy; the 
long continuance of the diarrhoea, the peculiar character of 
the discharge, the tenderness of the bowels, and general 
derangement of the system, are very marked symptoms. 

Prognosis. — The prognosis is favorable in those cases in 
which the disease is not of long duration, and in those in 
which there has not been much disturbance of the general 
health. When the system has suffered severely, all the func- 
tions being deranged, the prognosis is doubtful. 

Post-Mortem Examination.— The intestine is found in 
various conditions — sometimes thickening of the mucous mem- 
brane with discoloration and superficial ulceration, at others 
it seems to be softened, with a flocculent pultaceous material 
attached to it, or there may be deep ulceration or thinning of 
the mucous membrane, or dilatation or stricture, and in some 



Chronic Enteritis. 261 

cases perforation. Occasionally, from inflammation of the 
serous coat, the intestines are found tied together by a false 
membrane, or adherent to the other viscera. 

Treatment. — A very important point in the treatment of 
chronic diarrhoea is to establish all the secretions, and thus 
relieve the mucous membrane. Thus, the judicious use of the 
bath with friction, simple cold, tepid or warm water in some 
cases ; the alkaline bath in others ; when there is deficient circu- 
lation and tendency to coldness of the extremities, the addi- 
tion of Capsicum to the water ; or if the skin is relaxed and 
flabby, a decoction of tonics and astringents, as Hydrastis, 
Cornus or Que reus, are valuable means. A solution of Chlo- 
rate, Acetate or Citrate of Potassa with Essence of Juniper, 
or similar combination, answers a good purpose to stimulate 
the kidneys to action. 

If there is torpor of the liver, and congestion of the porta]; 
circle, this will have to be overcome; for, as long as it con- 
tinues there will be an excess of blood in the diseased struc- 
ture. For this purpose we use the Leptandrin in doses of two 
or three grains three times a day ; or the Podophyllin well 
triturated with Loaf Sugar, and given in small doses. Some 
times I prefer the "White Liquid Physic referred to in the pre- 
ceding disease, given in doses sufficient to stimulate the liver 
to action and change the character of the evacuations. A 
friend of mine places great confidence in this, and follows it 
with Quinia and Hydrastin, repeating the Physic whenever 
the discharges look bad. 

I have had most marked success with the Epilobium in very 
severe cases. I employ it in infusion, adding Brandy and 
sweeten to render it pleasant. Of the strong infusion I give 
a tablespoonful an hour, and continue it until the discharges 
are checked. The Geranium may be used in the same way, 
after the administration of the Leptandrin, as may also the 
Marsh Rosemary. The Persulphate of Iron answers an excel- 
lent purpose in some cases, in doses of from two to five grains 
four times a day ; of course it must not be given with the vege- 
table astringents. The Comp. Powder of Rhubarb and Potassa 
gives a valuable adjunct to these means, and is best used in 
the form of infusion. 

Counter-irritation can not be dispensed with. In the severer 
cases, I employ the irritating plaster used as heretofore recom- 
mended, and persisted in until the disease yields. If not so 



262 The Eclectic Pkactice of Medicine. 

severe, I sometimes use Turpentine stupes, or a strongly stimu- 
lating liniment. In others, the Vinegar bandage, worn con- 
stantly, or only at night, answers the purpose ; and again, the 
wet bandage may be used at night. If there is irritation of the 
spine, with tenderness, counter-irritation must be employed 
to remove it. 

The bitter tonics and stimulants answer a good purpose after 
we have modified the diseased action, and improved the secre- 
tions. Quinia and Hydrastin are best where there is febrile 
action in the afternoon and evening; but in other cases, I 
usually employ, #, Essl. Tincture of Colliusonia, Essl. Tincture 
of Cornus, Glycerin, Simple Syrup, aa, 3ij ; in doses of a tea- 
spoonful every three hours. If there is derangement of the 
stomach, with increased secretion of mucus, with a bad taste 
in the mouth and nausea, use the Oxide of Zinc in doses of one 
grain four or five times a day. The Gin Bitters are an excel- 
lent stimulant, when this is required. 

Strict attention should be given to the patient's diet, that it 
be nutritious, easily digested, and leave but little debris. Still, 
we find many cases in which the appetite seems to be the best 
judge of what is beneficial to the patient. Gentle exercise in 
the open air, and a residence on high ground, is of marked 
benefit. 



SPLENITIS. 

Diseases of the spleen are somewhat obscure, the symptoms 
not being very well marked, and the derangements of function 
consequent upon it being as various. If we except acute in- 
fiammation of this viscus, there are no other diseases that will 
present more uncertain symptoms. We can readily see why 
this is, if we call to mind its situation and structure, and what 
we know of its function. Situate in the right hypochondrium, 
it is readily moved in all directions, and can occupy a less or 
greater space without any or but slight derangement of func- 
tion of adjacent parts. In structure it is adapted to permit of 
great distension and enlargement, and a greatly increased or 
diminished circulation of blood. Its function is very obscure; 
all that we know definitely is, that it serves as a diverticulum 
for the blood of the portal circulation, and in some manner 
caters to the liver, preparing the blood for it. In addition, it 
would seem to exert a devitalizing influence upon the red- 



Splenitis. 263 

globules, they being broken down in the splenic vein to a 
greater extent than in other portions of the system, and to gen- 
erate white-globules, they being in excess in this vein. The 
last proposition is still further proven by the fact that in cases 
of leucocythemia the spleen is invariably hypertrophied. 

Symptoms. — Acute splenitis most generally results from injury 
though it may in some cases arise during disease of the liver 
or intermittent fever. If it does not arise during intermittent 
fever, a remittent fever invariably comes up with it. The first 
evidences of disease make their appearance with a marked 
chill or rigor, the patient complaining of a sense of fullness 
and deep-seated pain, or soreness in the region of the spleen. 
Febrile action follows the chill, and is usually pretty severe. 
The tongue is heavily coated at the base, the mouth clammy 
and frequently bitter ; there is nausea and vomiting, some- 
times of bile; headache is a prominent symptom — dull, heavy, 
with occasionally sharp, shooting pains, the bowels are cos- 
tive, the skin hot and dry, and urine scanty and high-colored. 
With the development of febrile action, the pain in the side 
becomes more severe, and is tensive and tearing in its charac- 
ter, shooting over to the stomach and liver, and upwards to 
the back and left shoulder. 

The fever is almost always remittent, the remissions occur- 
ring in the early part of the day. Frequently they become 
more and more obscure, until it seems that the fever is con- 
tinuous. If it progresses without amendment, we find the 
patient becoming more and more prostrated, the digestive 
organs very much deranged, as is evidenced by the brown 
coating of the tongue, entire want of appetite and frequent 
nausea, offensive evacuations from the bowels, etc., and the 
fever assuming a typhoid type. 

Chronic splenitis is usually associated with intermittent fever, 
or disease of the stomach or liver. It comes on slowly, and is 
evidenced by a feeling of tension in the region of the spleen, 
soreness on deep pressure, and an occasional sharp pain, which 
seems to catch the patient, and suddenly arrest all exertion. 

Hypertrophy of the spleen, or ague cake, may be considered 
as the result of, or attendant upon sub-acute or chronic inflam- 
mation. It is almost invariably an attendant of protracted 
cases of intermittent fever, the associate organs, the stomach 
and liver, being more or less affected. The size of the spleen 
varies very greatly in these cases, sometimes increased to 



264 The Eclectic Practice of Medicine. 

twice its original size, at others enlarged so as to occupy the 
greater portion of the left side of the abdomen. In these 
cases there is a feeling of weight, tension and distress, hardly 
amounting to pain, unless the patient takes active exercise, 
when there are the sharp catches heretofore named ; in conse- 
quence of these he is frequently unable to take as much exer- 
cise as his health would permit him. 

When the result of intermittent or remittent fever, we find 
the patient decidedly cachectic ; the skin sallow, wrinkled 
and harsh, urine variable, sometimes scanty and high-colored, 
at others, very abundant, and of low specific gravity; the 
bowels irregular, sometimes constipated, at others diarrhoea; 
frequently a good appetite, but the food imperfectly assimil- 
ated, so as not to increase the strength, and more or less dis- 
turbance of the nervous system manifested by pain in the 
head, back and limbs, restlessness at night, bad dreams, low- 
ness of spirits, etc. When idiopathic, the patient notices first 
the enlargement and uneasy sensation in the left side, and as 
the enlargement increases, there is gradually developed the 
symptoms above named. 

Diagnosis. — The diagnosis of acute splenitis is made from 
the location and character of the pain, the tenderness on deep 
pressure, and the marked constitutional disturbance. The 
sub-acute and chronic forms are more difficult to determine; 
the deep-seated pain and soreness, with enlargement, the ina- 
bility to take active exercise on account of the sharp, catching 
pain in the side, and very marked derangement of the digest- 
ive organs, with general cachexia, are the most predominant 
features. 

Prognosis. — The prognosis is favorable in a majority of 
cases, of either form of the disease. Occasionally suppuration 
occurs, marked by rigors and low ataxic fever, in which recov- 
ery is impossible. In enlargement of the spleen, the result of 
intermittent fever, we- can usually assure the patient of recov- 
ery; but if the splenic enlargement was the original affection, 
the cachectic symptoms depending on it, the result will be 
fatal in a majority of cases. 

Post-Mortem Examination. — In inflammation of the spleen, 
it is usually found enlarged, and its external coat of a deeper 
or browner red than in health. The structure is generally 
very much softened, breaking down under the slightest press- 
ure. The internal structure is frequently grayish and soft- 



Splenitis. 265 

ened, and if suppuration has occurred, the pus will be found 
in isolated portions within the trabecula, or in some cases 
forming an abscess, and surrounded by a well-defined pyogenic 
membrane. In cases of hypertrophy, we frequently find the 
structure of the organ unchanged; at other times there 
has been more or less deposit of plastic lymph, which has 
become organized. 

Treatment. — Acute splenitis should be treated in a very 
similar manner to hepatitis. If there is nausea and vomiting, 
an emetic should be administered to thoroughly free the stom- 
ach and quiet it. Following this, we would give the special 
sedatives in doses sufficient to control the fever, and when this 
has began to subside, add a diaphoretic and an alkaline diu- 
retic. If the bowels are obstinately constipated, and there is 
deficient action of the liver, I would give a cathartic of Podo- 
phyllin and Leptandrin, otherwise the bowels should be opened 
with Compound Powder of Jalap, or similar remedy. Wet or 
dry cups, followed by hot fomentations, are the best local appli- 
cations to the region of the spleen, but the action of the rein- 
dies named, may be much facilitated by the use of the general 
alkaline sponge bath, and hot Mustard foot bath. With the 
first appearance of remission, the Sulphate of Quinia with 
Prussiate of Iron, or Hydrastin, should be administered in full 
closes, and repeated daily until the fever is arrested. 

In the chronic form of the disease, I have obtained the best 
results from a course of treatment calculated to stimulate all 
the excretory organs. Among the most prominent remedies 
are the alkaline diuretics, Acetate and Citrate of Potassa 
which may be given in solution, in quantities of from 3ij to 
3iij, in the course of twenty-four hours; at the same time, I 
usually administer the vegetable alteratives, with bitter ton- 
ics, as #, Compound Tincture of Corydalis, giijss; Essl. Tinc- 
ture Hydrastis, 3ss; in doses of a teaspoonful four times a day. 
If this is not sufficient to overcome constipation, a small por- 
tion of the Tinctures of Podophyllum and Leptandra may be 
added; or, #, Essl. Tincture of Cornus, Essl. Tincture of 
Euraex, Essl. Tincture of Collinsonia, aa, 3j; Essl. Tincture of 
Podophyllum, 3ij ; Glycerin, Simple Syrup, aa, gjss; M., and 
give in doses of a teaspoonful every three or four hours. If 
there should be diarrhoea, the use of the Syrup of Rhubarb 
and Potassa, with Paregoric, and a vegetable astringent, usu- 



266 The Eclectic Practice of Medicine. 

ally answers the purpose. The persistent use of the bath, as 
heretofore recommended, is not to be neglected. 

Just as soon as we have made a decided impression on the 
secretions, and they are commencing to act well, we may use 
Quinia with the most marked advantage; but previous to this 
it would have been injurious rather than beneficial. When 
used, I usually give it in quantities of from twelve to fifteen 
grains, sometimes more, during the forenoon. If it seems to 
check the secretions, or causes uneasiness or debility, its use 
should be stopped, and the other medicines continued. 

Hypertrophy of the spleen is treated in the same manner, 
depending almost entirely on the alkaline diuretics, and the 
judicious use of baths at first, then adding the vegetable altera- 
tives and bitter tonics, and finally, when secretion is tolerably 
freely established, bringing the Quinia to bear on the disease. 
The most marked success will generally follow this treatment, 
whereas, if reversed or mixed up, it will frequently fail. 

In chronic inflammation or hypertrophy, we occasionally 
find a persistent derangement of the stomach, marked by foul 
tongue, bad breath, variable appetite, and more or less nausea 
and vomiting. "While this continues, measures for the relief 
of the diseased spleen will have no effect. In such cases, if 
not removed in a reasonable time by the alkaline diuretic, I 
should advise the use of a thorough emetic two or three times 
a week. In persistent cases, we obtain great advantage from 
the irritating plaster, as in other chronic inflammations. 



DISEASE OF THE PANCKEAS. 

The pancreas have been found diseased on post-mortem 
examination, but it has been very rarely determined during 
life. Situated so deeply in the abdomen, and covered by the 
stomach and intestines, seemingly without sympathy with 
other parts, we can well understand why the symptoms should 
be obscure. The function of the organ is not very well under- 
stood, but we know that it exercises a very important influ- 
ence in changing chyme into chyle, and possibly the changing 
chyle into blood. According to Bernard, the pancreatic fluid 
is the principal agent in the digestion of fatty matters. This 
is proven by the fact that when the pancreas is diseased, or 
its duct obstructed, so as to arrest the formative influence of 
its secretion, great emaciation and anaemia occur. 



DlARRHCEA. 267 

Acute inflammation is said to be characterized by an acute 
and deep-seated pain below the pit of the stomach, and 
extending back and below the left shoulder-blade. There is 
a sense of anxiety at the prsecordia, with burning and con- 
striction in the stomach, dryness of the fauces, and thirst. 
Occasionally there is derangement of the stomach, with vom- 
iting of a ropy, mucous fluid ; sometimes a mucous diarrhoea 
occurs. "With these symptoms there is a more or less severe 
symptomatic fever. 

The more chronic forms of inflammation are accompanied 
by the same deep-seated pain, though not so severe, and the 
tension and heat are aggravated by taking food. In addition, 
there are various dyspeptic symptoms, as flatulence, pyrosis, 
heartburn, etc. In other structural lesions, there is more or 
less impairment of function, resulting in imperfect digestion 
and assimilation of food, and gradual marasmus. Cancer of 
the pancreas is the most prominent disease, and the one most 
frequently met with. 

Treatment. — Inflammation of the pancreas should be treated 
as any inflammatory disease of other organs. We reach an 
internal inflammation through the blood, and arrest it by 
checking the rapidity and equalizing the circulation, and by 
getting free action of the excretory organs; this can be 
accomplished in inflammation of the pancreas, as well as of 
other organs. We know of no remedy that acts specifically 
upon the pancreas, so that it would not benefit us if we could 
determine its functional diseases. 



DlARRHCEA. 

Diarrhoea is frequently symptomatic of other affections, or 
indicative of disease of the small intestines, as in the cases 
just noticed; but it is also, in many cases, an idiopathic disor- 
der. We may divide it with advantage into the following 
forms : 1st, From irritation of the intestinal canal ; 2d, From 
increased secretion of bile ; 3d, From atony of the intestines ; 
4th, From congestion of the portal veins, and determination of 
blood ; 5th, From increase of mucous secretion ; and 6th, From 
imperfect digestion. 

Symptoms. — Diarrhoea arising from irritation may be caused 
by acrid and irritating ingesta, or result from exposure to cold, 



268 The Eclectic Practice of Medicine. 

or from the arrest of other secretions. The operations are copi- 
ous and feculent, sometimes preceded "by griping pains, and 
occasionally attended with an urgent desire to go to stool. The 
tongue is usually loaded, an unpleasant sensation at the stom- 
ach, loss of appetite, and frequently a tendency to headache. 
As the diarrhoea continues the strength is materially affected, 
though there is no febrile action at any time. 

Bilious diarrhoea results from hyper-secretion of bile, and 
may arise from the causes named above. It is rather a com- 
mon form of the disease in the summer, and in hot climates, 
and in intemperate persons. The evacuations are at first fecu- 
lent, but green or greenish-yellow, and pultaceous; but as the 
disease advances, are more profuse and watery. If it contin- 
ues for some time they frequently contain more or less mucus, 
sometimes in loose pieces, at others in thin, glairy and gela- 
tinous pieces. There is sometimes a feeling of tension in the 
right side, and soreness on pressure ; and there is considerable 
griping pain attending and preceding the discharges from the 
bowels. The skin is dry and harsh in many cases, and the 
urinary secretion scanty and high-colored; the tongue coated, 
a bitter taste in the mouth, and loss jof appetite, with sensa- 
tion of nausea and disgust. 

Atony of the intestinal mucous membrane gives rise to 
diarrhoea by the relaxed vessels allowing their contents to escape. 
In all diseases attended with great loss of power, we have 
examples of such profluvia, as in asthenic bronchitis, the 
oedema of local debility, etc. In this case, the operations are 
large and watery, or in some cases a watery mucosity, unat- 
tended with pain or suffering of any kind. The discharges 
pass so freely that the patient has sometimes but little notice 
to prepare for them, or they pass almost involuntarily. There 
is loss of appetite to some extent ; the skin is cool, pale, soft 
and relaxed, with perspiration ; the urine light-colored and of 
low specific gravity. The debility is marked. 

Determination to the intestines, accompanied by partial con- 
gestion, gives rise to a diarrhoea, attended by large and fiuid 
evacuations. There is more or less soreness of the bowels and 
griping pains preceding the operations. The stools are of 
every shade of color, from pale clay to a greenish, or brown 
color, and are sometimes preceded by nausea. The skin is 
usually dry and harsh, the pulse hard, the tongue coated, 



DlARRHCEA. 269 

appetite gone, urine scanty, some headache, with tumid bow- 
els and some pain- or soreness on pressnre. 

Increased mucous secretion gives rise to that form of diar- 
rhoea termed catarrhal. It occurs more frequently in old 
persons and children, though it may affect all ages. The 
stools consist of mucus with a small proportion of feculent 
matter, sometimes large, thin and gelatinous, looking like 
semi-transparent mucilage, at others, thick and white, or 
colored by the faeces. At first it gives rise to but little dis- 
turbance, but as it continues, the strength fails, the skin 
becomes dry and harsh, the appetite much impaired, with great 
loss of strength and emaciation. 

Diarrhoea from imperfect digestion is known by the name 
of lientery; it is most frequently observed in children, and 
rarely in adults. It is undoubtedly owing to imperfect action 
of the stomach, and increased peristaltic action of the bowels. 
The evacuations consist in part of faeces, and in part of food, 
which is discharged from the bowels in nearly the same con- 
dition in which it passed into the stomach. Sometimes there 
is pain attending the operations, but at others none, except a 
feeling of rawness and soreness of the rectum; if it continues, 
the patient soon' exhibits the effects of arrest of digestion, in 
a marked marasmus, terminating in stupor and death by 
exhaustion. During the entire period the appetite is usually 
good, sometimes voracious, and there is no manifest lesion of 
any other function. 

Diagnosis. — Diarrhoea is very easily diagnosed, and an 
examination of the discharges and the symptoms will 
determine its character; this should always be done, as the 
injudicious use of astringents sometimes gives rise to serious 
difficulty. 

Treatment. — Common feculent diarrhoea frequently requires 
no treatment, as when the irritating matters are removed, it 
ceases itself. If, however, there is much griping, with colicky 
pains, the Compound Powder of Jalap and Senna may be 
administered in scruple doses every four hours, until there is a 
free evacuation and a cessation of the pain. Following this, 
if necessary, we may give Compound Syrup of Rhubarb and 
Potassa, 3jss; TincturaOpii Camphorata, 3ss; M., ateaspoonful 
every hour or two; or if necessary, an astringent, as the Tinc- 
ture of Catechu, Kino or Geranium. 



270 The Eclectic Practice of Medicine. 

In bilious diarrhoea, I usually employ #, Leptandrin, 
Dioscorin, Geraniin, aa, grs. x; Opium, grs. v; M., and divide 
into ten powders, of which one may be given every two hours. 
Or, Essl. Tinct. Leptandra; Essl. Tinct. Dioscorea, aa 3ss; 
Compound Syrup of Rhubarb and Potassa, 3ij ; in doses of a 
teaspoonful every two hours, until the discharges are changed, 
when we may substitute an astringent if necessary. If there 
is much febrile action, or, the skin is dry and harsh, the hot- 
Mustard foot bath, with a bowl of hot Pennyroyal, or Sage tea 
will be beneficial, and if considerable pain or griping, a Mustard 
plaster to the bowels. 

Diarrhoea from atony should be treated with stimulants and 
astringents. I have used the Aromatic Tincture of Guiacum 
with and without Tannic Acid, in doses of a teaspoonful every 
hour with most marked success. Or, #, Oil of Cajeput, Oil 
of Anise, aa, 3j ; Alcohol, 3j ; Syrup of Rhubarb and Potassa, 
f3ij ; M., and give in the same doses. Or, Leptandrin, grs. x; 
Capsicum, Opium, aa, grs. v ; M., and make ten powders, of 
which, one may be given every two hours ; in mild cases the 
common astringents will prove sufficient. 

In diarrhoea, the result of determination and congestion, if 
severe, I order cups to the abdomen, followed by warm fomen- 
tations, the hot Mustard foot bath, and in some cases the spirit 
vapor bath, with the internal administration of Leptandrin, 
and a demulcent. Or, we may use the White Liquid Physic 
in this case with advantage ; following it with the Syrup of 
Rhubarb and Potassa. In some of these cases, I alternate the 
Leptandrin with the Sub-nitrate of Bismuth, in doses of five 
grains ; if symptoms of atony result, with loss of strength, the 
stimulants first mentioned should be employed. 

In mucous diarrhoea, we frequently find it advantageous to 
clear the bowels by a mild purgative; for this purpose, Castor 
Oil and Turpentine, or, the White Liquid Physic, or, the Com- 
pound Powder of Rhubarb, or Leptandrin and Jalap, with small 
doses of Podophyllin thoroughly triturated with Loaf Sugar 
may be used. This should be accompanied by the hot foot bath, 
and Compound Powder of Ipecac and Opium, and if there is 
any tenderness of the bowels, a sinapism, with hot fomentation, 
the hot sitz-bath, or the wet bandage; after the bowels are 
evacuated, the Syrup of Rhubarb and Potassa, with Essl. 
Tincture of Leptandrin will usually be sufficient, if not, it may 
be alternated with one of the vegetable astringents. In some 



Cholera Morbus. 271 

cases, the stomach being much deranged, it is advisable to 
commence the treatment with an emetic of Ipecacuanha. 

Lienteric diarrhoza should be treated by the use of the bath 
with brisk friction, the Vinegar bandage to the lower part of 
the trunk, or some stimulant embrocation; bland and easily 
digested food, and exercise in the open air. Internally I use 
the Hydrastin and Leptandrin, with a solution of Chlorate of 
Potassa and Carbonate of Ammonia. The White Liquid 
Physic will be found a good remedy, as will also the dilute 
Nitric Acid, with Simple Syrup. Quinia with Hydrastin 
seems sometimes to answer an admirable purpose, and with 
the mineral acids is sufficient for the relief of the disease. 



CHOLERA MORBUS. 

Cholera morbus is usually caused by acrid or irritating 
ingesta, or from long-continued torpor of the intestinal canal, 
the secretions being thereby retained, or from sudden changes 
of temperature, or arrest of secretion in the warm months of 
the year. It usually comes on in the summer and autumn and 
in some years more than in others. 

Symptoms. — It usually makes its appearance with pain about 
the umbilicus, and a feeling of nausea and prostration, and 
desire to evacuate the bowels. In a short time a diarrhoea sets 
in, the discharges being large, fluid, and to some extent fecu- 
lent; usually, the nausea soon passes to vomiting, the attack 
coming on with the disposition to go to stool, and being long 
continued and attended with much straining. The pain in the 
bowels varies greatly, in some cases being extremely intense, 
at others but slight; the stools vary in character, in some cases 
yellow, or yellowish brown, and accompanied by vomiting of 
bile, at others becoming lighter and lighter in color, until they 
seem nothing but water with whitish flocculi in it, like the rice- 
water discharges of Asiatic cholera. The first variety has 
taken the name of bilious cholera; in other cases, the bowels 
seem to be distended with gas, the patient passing considera- 
ble flatus at stool; this is termed flatulent cholera. 

As the disease progresses, the patient's strength becomes 
exhausted, the vomiting or retching is more severe, the dis- 
charges from the bowels more frequent, and the pain severe 
and less easily borne. Now, the spasmodic action of the mus- 



272 The Eclectic Practice of Medicine. 

cles of the lower extremities frequently ensue, and sometimes 
of the abdominal muscles; the cramps are exceedingly pain- 
ful, and cause the patient to cry out with pain when they 
come on. The pulse is now small and fluent, the extremities 
cold, and the surface bathed in a cold clammy perspiration. 
If not arrested, we find that the sufferer's strength is gradu- 
ally exhausted, the mind wanders, and the patient dies. 

Diagnosis. — We recognize an attack of cholera morbus from 
the large fluid evacuations, pain in the bowels, great prostra- 
tion at the commencement, nausea and vomiting, and cramps 
of the extremities, and of the abdominal walls. 

Prognosis. — The prognosis is favorable if taken in time, and 
properly treated; but if allowed to run until the system is 
much exhausted, it may prove fatal. 

Post-Mortem Examination. — ~No lesion accounting for death 
is found; the mucous membrane of the intestines seems 
blanched, excepting in cases of bilious cholera, when they are 
colored by bile; all the parts of the body shrunken, and the 
blood thick and grumous. 

Treatment. — Though a severe disease, the treatment is the 
simplest possible. We administer at first the Compound 
Tincture of Cajeput, in doses of a teaspoonful every fifteen 
minutes, until the patient feels a sensation of agreeable 
warmth in the stomach, and then at less frequent intervals. 
This almost invariably checks the vomiting, and in a large 
majority of cases, the diarrhoea. Another very efficient rem- 
edy is the Aromatic Tincture of Guiacum, given in the same 
doses. If the nausea is not controlled by these means, we 
may give an infusion of Peach-tree bark, or of the Compound 
Powder of Rhubarb in small doses, or of Sub-nitrate of Bis- 
muth, or Morphia: usually these means are not required. - 

A sinapism to the epigastrium, and extended over the entire 
surface of the bowels, and followed by hot fomentations, 
afford marked relief in some cases. I prefer, however, the 
application of a towel wrung out of cold water. The hot 
Mustard foot bath may be used with advantage, and in some 
cases the vapor bath. If the cramps are severe, friction with 
Mustard will give relief; or in worse cases, we use the Com- 
pound Tincture of Cajeput. In very severe cases, the surface 
being cold, and the pulse hardly perceptible at the wrist z the 
patient may be wrapped in a blanket wrung out of hot Mus- 
tard and water. 



Asiatic Cholera. 273 

ASIATIC CHOLERA. 

A disease having some semblance to cholera was partially 
described by the Greek physicians, which was probably our 
cholera morbus. Again, in 1689, Dellen described a disease 
very much like it. 

It was not until from 1774 to 1790, that the disease we know 
as Asiatic cholera made its appearance, and was then confined 
to India, though committing great ravages in the Bengal 
army, it is still believed by many that even this was cholera 
morbus. The descriptions are so imperfect that it is difficult 
to determine the character of the affection, and as it was so 
much milder than the cholera of the present century, we may 
consider it as not being a variety of this disease. 

In August, 1817, the terrible disease known as Asiatic or 
spasmodic cholera made its appearance at Jessore, about a 
hundred miles north-east of Calcutta; it reached the latter, 
place early in September, having destroyed thousands of the 
inhabitants in its course. It gradually passed over the Indian 
Peninsula, and had by 1823 extended itself in one direction, 
to the shores of the Caspian Sea, and in another as far as the 
Mediterranean and. the borders of Russia; during this time 
it counted its victims by millions, nearly depopulating certain 
sections of country. In 1831, it again made its appearance in 
Russia, and extended over Europe, reaching England in 
October of this year. It appeared on this continent at 
Quebec, on the 10th of June, 1832, and at K"ew York on the 
24 th of the same month. Its spread in the United States 
was rapid, and its mortality fearful, and it did not entirely 
cease until 1834. 

Its second appearance in this country, and the third chol- 
eraic pestilence that we have accounts of, occurred in 1849. 
As before, it spread rapidly, and the mortality was very great. 
It seemed to be confined to no age or condition, but attacked 
the population indiscriminately. It recurred in 1850, 1851, 
and in a sporadic form in 1852, having thus lasted four 
years. The causes of cholera are not known; many ingenious 
speculations have been made, but we are no nearer the truth 
than we were at the commencement of the first epidemic. 
It undoubtedly depends upon some peculiar constitution of 
the atmosphere, which once generated in India, was gradually 
propagated over the entire globe. 
18 



274 The Eclectic Practice of Medicine. 

Cholera is generally believed to be contagious, and its epi- 
demic progress, and extension along traveled thoroughfares, 
and its appearance on the sea-board only when a vessel has 
come from an infected port, is urged as proof. We grant 
these are facts, and further that many cases are known, in 
which the commencement of the disease in a place immedi- 
ately succeeded the introduction of a person laboring under 
cholera from a place where it prevailed. Or, that it appeared 
first in a person coming from an infected district, possibly to 
escape the malady, and after two, three or more days had 
elapsed; and that the disease where it once appeared in a 
house was rarely satisfied with one victim. Admit all this, and 
yet we see evidence sufficient to disbelieve its contagiousness: 
those who were most with it, who nursed in it, who took no 
precaution to avoid it, other than temperate living, rarely had 
the disease. It was more apt to attack those who secluded 
themselves from fear of the disease, and who used undue pre- 
cautions to avoid it. The poison is an atmospheric one, and 
though the seeds of the disease are propagated along traveled 
routes, yet where once disseminated in a place, the mere con- 
tact with a person having the disease is not likely to increase 
the danger. We may well compare it to the virus of small 
pox, the most minute portion being as potent, when introduced 
into the blood, as the largest quantity. 

Symptoms. — In some cases, the attack of cholera was pre- 
ceded by a serous diarrhoea, for two, three, or four days, but 
in a majority of cases, there were no premonitory S3 r mptoms up 
to the day of attack. Usually the first evidence of the disease, 
was a feeling of great prostration, and a copious evacuation 
from the bowels. With the first diarrhceal discharge, in many 
cases, the patient was completely prostrate, and would some- 
times pass into the collapsed stage with but two or three. 
At other times the discharges from the bowels were very 
frequent and large, and from their peculiar appearance, look- 
ing like the water in which rice had been boiled, denom- 
inated rice-water discharges. [Nausea with prolonged retch- 
ing and vomiting frequently came on with the first discharges 
from the bowels, or during the progress of the disease. 
With the full establishment of the affection, the extremi- 
ties were cold, and cold clammy perspiration made its appear- 
ance on every part of the body, sometimes it was so great 
as to stand in drops, seeming to be glutinous and sticking 



Asiatic Cholera. 275 

to the hand. The pulse was slow and feeble, the artery 
easily compressed, and the circulation arrested; gradually as 
the disease progressed, it failed more and more, until in the 
stage of collapse it could not be felt in the extremities. "With 
the full development of the disease, spasmodic action of the 
muscles, or cramps, would come on, usually at first in the 
lower extremities, but at last affecting all parts. 

The muscles would contract into hard rigid knots, the 
patient suffering excruciating pain, which was best relieved 
by compression and brisk friction. A marked change was 
now noticed in the appearance of the patient, he seemed to 
have lost flesh as much as he would in two or three weeks' 
sickness; the eyes were sunk in the head, the countenance 
pinched and contracted and of a ghastly white color, the lips 
and mouth of a leaden purplish hue. The disease continuing, 
it soon passes into the stage of collapse, the entire surface 
being cold and covered with a clammy perspiration, a remark- 
ably cadaverous appearance of the countenance, and a shrunk 
and shriveled skin. The pulse at the wrist is very feeble, 
and seems very much like drops of water trickling under the 
finger, and at last it is not perceptible. The discharges from 
the bowels are now involuntary, consisting of simple water, 
with the whitish flocculi heretofore named. The cramps still 
continue, frequently with increased severity. Sometimes the 
patient's mind wanders, but at others it is clear and composed 
to the last. 

The disease is of variable duration, sometimes terminating 
fatally in an hour or two, most generally within twenty-four 
hours, though in some rare cases it lasts two or three days. If 
it terminates favorably, we find that much care is necessary dur- 
ing convalescence, as the bowels are so feeble, and there has 
been such a severe shock to the system. A low grade of fever 
not unfrequently sets in after it, continuing for several days, 
and requiring careful management. 

Diagnosis. — Cholera is diagnosed from all other affections 
but cholera morbus with great ease, but from this, with the 
greatest difficulty ; as the symptoms are very nearly the same, 
differing but in severity. During the prevalence of an epi- 
demic of cholera, we are justified in considering all cases such, 
that are attended by rice-water discharges from the bowels, 
spasmodic action of the muscles, and prostration. 

Prognosis. — Though a disease usually attended with a fear- 



216 The Eclectic Practice of Medicine. 

ful mortality, "it is yet amenable to prompt and appropriate 
treatment. It was observed by our physicians in this city, 
that the mortality in their practice would not exceed five per 
cent. For my part, I think they claimed too much, and that 
many cases of common diarrhoea, which was prevalent at the 
time, were included in their enumeration. Still it is very evi- 
dent from the reports, that their success was very great. From 
what I know of the disease, I should consider a mortality of 
not over ten per cent, good practice. 

Post-Mortem Examination. — The lesions of structure in 
cholera are not very marked. The intestinal mucous mem- 
brane, where we should expect to find evidences of the disease, 
is but little changed, or presents evidences of congestion, it is 
usually covered with a whitish muco-albuminous matter, and 
the follicles are enlarged and tumified. The intestine is some- 
times much contracted, at others it is distended in certain 
portions with flatus. The surface of the body presents the 
peculiar contracted appearance, noticed during the latter stage 
of the disease, and the surface is covered by the sticky perspi- 
ration. Usually there is a peculiar cadaverous odor, which is 
frequently noticed during the latter part of the disease. The 
blood in the heart and large vessels is black and grumous, and 
the coats of the vessels frequently discolored from it. Dr. 
Cowan noticed a remarkable alteration in the blood of a cholera 
patient on microscopic examination. "It consisted in the col- 
ored corpuscles being paler than usual, and the colorless normal, 
but mingled with those were others varying in shape and size. 
They were generally circular, but some were oval, and a few 
caudate. They had a well defined external smooth border, 
having one or two bright refracting granules, generally situate 
in the external membrane, and occasionally projecting from 
it. When seen edgeways, they were flattened and existed in 
the proportion of one to seven of the colored corpuscles." 

It is deemed by some authorities that there is deficiency of 
the saline matter of the blood, and they attempt to account 
for the symptoms on this hypothesis, and base a treatment 
upon it. That there is deficiency of water after the evacua- 
tions become profuse, and that some of the s3 r mptoms are 
dependent upon the thickness of the blood there can be no 
doubt, but this is but the result and not the cause of the affec- 
tion. Like other of the more malignant affections the lesions 



Asiatic Cholera. 277 

are doubtless in the blood and nervous system, but we have 
yet to learn the means of analyzing them. 

Treatment. — The treatment I adopt in a case of cholera is 
such as will support the flagging powers of life, by strong 
• stimulation. It may not be successful in all cases, but I feel 
satisfied that it will be attended by as good results as any 
others. If there is irritability of the stomach with continued 
vomiting, so that remedies will not remain upon the stomach, 
I administer an emetic of the Compound Powder of Lobelia, 
or, of Salt and Mustard. In a majority of cases, however, 
•we have nothing better to settle the stomach than the Com- 
pound Tincture of Cajeput, or Hunn's Life Drops. It should 
be administered in doses of a teaspoonful every five or ten 
minutes, until the vomiting ceases, and there is returning 
warmth to the extremities, and feeling of heat when the medi- 
cine is taken, when it may be given less frequently. To aid 
its action, I direct flannel cloths wrung out of hot Mustard 
and water to be applied over the entire abdomen, or, if this 
seems impossible, we may use strong Salt water cold, or equal 
parts of Turpentine and Tincture of Camphor. If the case 
was approaching collapse, I should wrap the patient in a 
blanket, wrung out of Mustard and water, as hot as could 
be borne, or, if there were no facilities tor getting this, I 
would use the cold wet sheet pack, the water being pretty 
strongly impregnated with Salt. One application I am 
satisfied is as serviceable as the other, in fact I should prefer 
the last, if it were not so unpleasant, and objected to by 
the friends. 

The cramps are an exceedingly troublesome feature of the 
disease, and are best removed by friction with dry Mustard. 
This is also recommended to bring the circulation back to the 
surface, but without the slightest effect, until the internal 
remedies commence to affect the system. The Compound 
Tincture of Cajeput is much the best local application, if it 
were not so costly. 

The treatment named above seems very meager, and yet it 
is the best that I have tried myself, or witnessed with others. 
Other remedies possessing similar properties might be substi- 
tuted for the Compound Tincture of Cajeput, but I doubt 
their being equal, if as good. Those that seemed to exert the 
best influence, were the Tincture of Xanthoxylum, Aromatic 
Tincture of G-uiacum, andCamphor. j Other treatment pursued 



278 The Eclectic Practice of Medicine. 

during the last epidemic and recommended as successful, I 
will now proceed to name, quoting from the proceedings of 
the Eclectic Medical Society of Cincinnati. 

Dr. Morrow stated that he had found no remedy better than 
the Aromatic Tincture of Guaiacum (Guaiacum, Cinnamon, 
Cloves, each, 3j ; best Brandy, Oj ;) in doses of a teaspoonful 
every fifteen or twenty minutes. In some cases where there 
was excessive nausea, he had found it best to give an emetic, 
preferring the Acetous Tincture of Lobelia and Sanguinaria, 
with one-third of the Tincture of Aralia Spinosa. The ex- 
ternal application of heat, and in some cases the hot blanket, 
he considered important. He had also used Hunn's Life 
Drops and Camphor with success. 

Dr. King recommended #, Ox Gall, 3j ; Capsicum, Gum 
Guaiac, aa, Giv; Leptandrin, 3iv; M., this was given in doses 
of a grain, and repeated two or three times a day. He had 
also succeeded in many cases with a mixture of #, Sulphur 
Subl., grs. iv ; Gum Guaiac, Charcoal, aa, grs. ij ; Camphor, gr. 
j; Opium, gr. ss; M., in doses of from one to two grains every 
ten minutes, until relief is experienced. He had also employed 
the spirit vapor bath, with brandy and aromatics, the patients 
recovering. He had also used the Tincture of Xanthoxylum 
and Hunn's Life Drops, with advantage; and in one case a 
teaspoonful of Black Pepper, one of table Salt and five of 
Yinegar to half a tumbler of hot water. 

Dr. Newton employed the Tincture of Xanthoxylum, and 
equal parts of Tannin, Capsicum, Camphor and Kino, in doses 
of one grain of each repeated at short intervals, until the dis- 
charges were checked. The Xanthoxylum he considered the 
most powerful remedy to equalize the circulation with which 
he was acquainted ; he employed it, both by mouth and enema. 

Dr. Wright used Neutralizing Extract^ Tincture of Xan- 
thoxylum and Compound Tincture of Guaiacum; the best 
external applieatioon he had found, was equal parts of Salt, 
Capsicum and Mustard; in the spasmodic stage he used 
Thompson's third preparation of Lobelia. 

Convalescence should be managed with care, the patient 
should be kept calm, avoiding all causes of irritation; the 
food should be bland, and taken in small quantities; exercise 
in the sun should be avoided; and the bitter tonics with a 
small amount of stimulants employed. If fever should arise, 
it will be dependent in part upon gastro-intestinal irritation, 



Cholera Infantum. 279 

which should be closely watched, and the fever treated as 
heretofore recommended. 



CHOLERA INFANTUM. 

Cholera infantum, or summer complaint, [is a disease of very 
frequent occurrence, and one of the most difficult that we are 
called to treat. It occurs usually, during the second summer, 
or the period of first dentition, but may come on as early as the 
age of six or eight months, or as late as the third or fourth 
year. It is difficult to determine why at this time the child 
should be so susceptible to gastro-iutestinal irritation. 

Many have urged dentition as the cause, but as that is a 
physiological process, except when disturbed, we would expect 
to find the disease only in cases of dental irritation, whereas 
we find it in children who have no teeth, who are not cutting 
teeth at the time the disease commences, who have all their 
deciduous teeth, except the four last molars, or who show no 
swelling, tenderness or irritation of the gums. We would 
rather conclude, that at this period there is a change in the 
system, consequent upon the change in the food of the child, 
and its being no longer dependent upon its mother for sus- 
tenance. If the child is of vigorous parents, robust and 
healthy, this change is effected without disease, but if of feeble 
vitality, cholera infantum is almost sure to result. 

It occurs during the summer, usually making its appearance 
in June and July, and in the severer cases, lasting until frost 
and cool nights in the fall. A continuous high temperature 
has much to do in bringing it on, and it is more frequent in 
seasons in which this is the case. As the weather becomes 
cool in the fall it is mitigated, and with the appearance of 
frost it ceases, though we find that the sudden changes to cold 
during the summer are rather injurious, than otherwise. 

Symptoms. — We may divide cholera infantum, first, into the 
acute and chronic; and second, into febrile and non-febrile; 
the distinction in many cases being marked and the treatment 
different. 

Acute cholera infantum is frequently preceded for some 
days, or sometimes for a week or two, by a common feculent 
diarrhoea. It gives rise to but little uneasiness, as the child's 
appetite is not impaired, it sleeps well at night, plays as 



280 The Eclectic Practice of Medicine. 

usual, though there is some loss of flesh. All at once it seems 
to he very much prostrated, the discharges from the bowels 
are frequent, and there is continuous nausea, with inability to 
retain either fluids or solids upon the stomach. The thirst is 
extreme, the child constantly desiring water, but when given 
it is immediately rejected from the stomach. In some cases, 
the skin is harsh and dry, and the pulse hard and increased 
in frequency ; in others the skin is soft and doughy, the 
extremities cold, and the pulse feeble and frequent. 

Occasionally the brain is affected, there being congestion, 
or a low form of determination, or effusion; I recognize these 
cases by the extreme restlessness when there is determination, 
and a continued rolling of the head from side to side, and 
stupor, in the other cases. 

The disease may terminate fatally during the first twenty- 
four hours, or may continue for three or four days, or 
gradually pass into the chronic form. 

Chronic cholera infantum usually makes its appearance at 
first as a simple diarrhoea, which gives little uneasiness and 
seems not to affect the health of the little patient. After con- 
tinuing thus for a week or two it is noticed that the child is 
becoming very thin in flesh, its appetite is impaired, it is very 
thirsty, and when the stomach is overloaded there is nausea 
and vomiting. As the disease progresses, the desire for drink 
becomes more craving, the evacuations from the bowels more 
frequent, and the little patient wasted to a mere skeleton of 
its former self. The discharges from the bowels vary much 
in character in different cases, and even in the same case at 
different times. Sometimes they are yellowish, with more or 
less stringy mucus mixed with them, showing disease of the 
mucous follicles ; at others they are greenish, and have a sour 
smell; at others, clayey; again, almost white, and rarely a 
dark-brown or black. 

In febrile cholera infantum, the skin is harsh, dry and 
constricted, in some cases seeming to be drawn upon the 
patient like parchment. There is great irritability of the 
nervous system, the patient being restless and uneasy, never 
satisfied, always changing its position, wanting everything, 
satisfied with nothing, and especially restless and wakeful at 
night. The child seems to be worse in the after part of the 
day and evening, and frequently every other day. When the 
disease becomes very severe, it is almost impossible to keep 






Cholera Infantum. 281 

the child in bed at night, the heat seems to tortnre it, and it 
is only satisfied when laid where it can turn freely about, or 
when carried from place to place. 

In the non-febrile form, the skin is soft, relaxed and flabby, 
the extremities cool, the bowels distended or pendulous, the 
tongue broad, flabby and coated, and the pulse small, soft 
and fluent. The child is not so restless as in the preceding 
case, seems stupid and dull when nursed or in a comfortable 
position, but wants its own way. In both cases the appetite 
is alike impaired, there is the same nausea, the same desire for 
drink, and the same prostration of strength. 

We sometimes find the brain seemingly affected in these 
cases, when there is a continued moving of the head from 
side to side, the child sleeping with its eyes partly open, and 
rolling the eyeballs upward. If the pupils are somewhat 
dilated and do not contract freely upon exposure to light, I 
am satisfied there is congestion with effusion, and consider the 
patient's prospects very poor. Occasionally determination to 
the brain sets in, the head is hot, there is throbbing of the 
carotid arteries, contraction of the pupil, and intense restless- 
ness and uneasiness. 

Diagnosis. — The diagnosis of cholera infantum is very easy; 
the frequent discharges from the bowels, the intense desire for 
drink, nausea and vomiting, loss of flesh, and great prostration, 
can not be mistaken. 

Prognosis. — The prognosis is favorable except in those 
cases in which there is disease of the brain, generally acute 
hydrocephalus, or as described by Marshall Hall, hydrocepha- 
loid disease, in which the mortality will be very great. These 
are most frequently cases which have been neglected in the 
commencement, but sometimes the brain disease precedes the 
diarrhoea. 

Treatment. — In acute cholera infantum, as well as in 
chronic, the first object is to arrest the nausea and vomiting. 
For this purpose we may use an infusion of the Compound 
Powder of Rhubarb in small doses, repeated every ten or 
fifteen minutes; or an infusion of Menthse Piperita or Yiridis, 
or of Peach-tree bark, or Sub-nitrate of Bismuth, or minute 
doses of Morphia or of Aconite; or a strong stimulant, as 
Compound Tincture of Cajeput, or Chloroform, or Sulphuric 
JEther, taken by mouth. This is rather an extensive cata- 
logue of means, but it would seem desirable in some cases if 



282 The Eclectic Practice of Medicine. 

it could be increased. The infusion of Peach-tree bark I 
value very highly; I direct the bark of the young limbs to be 
scraped off, put in a vessel and covered with boiling water ; 
when cold it is ready for use. The vessel containing it may 
be set on ice to render it cold, and it may be administered in 
doses of half a teaspoonful every fifteen or thirty minutes. 
"When prescribing the Bismuth it is usually in the following 
form: #, Sub-nitrate of Bismuth, 3 j ; Aqua Menthse Yiridis, 
5ii; shake thoroughly, and give in teaspoonful doses every 
hour. Morphia should never be administered for this purpose 
when there is the least evidence of nervous prostration; and 
when given it should be in doses not larger than the one- 
twentieth of a grain. Aconite may be used in cases where 
there is irritation of the nervous system, with dry skin and 
hard pulse. The stimulants are used with greatest advantage 
in those cases attended by marked prostration, with coldness 
of the extremities. In some cases, we may use an emetic. 

External applications are sometimes of great advantage ; 
to the epigastrium we may apply a sinapism, or in very acute 
cases a fly-blister, or an aromatic poultice, composed of equal 
parts of ground Cinnamon, Allspice, Cloves and Mustard, or 
the Tinctures of the Oil of Cinnamon, Cloves and Anise. 
Sometimes hot fomentations seem to give great relief, and are 
indicated in those cases attended with coldness of the surface. 
When the skin is hot and dry, I prefer a towel wrung out of 
cold water to the abdomen, or in some cases, the wet sheet 
pack. 

"With the arrest of the sickness of the stomach the worst 
difficulty is over, for though we may not control the diarrhoea 
at once, we will have placed our patient in such a condition as 
to give us time. In many cases the administration of an 
infusion of the Compound Powder of Rhubarb in teaspoonful 
doses every hour, until it changes the character of the evacu- 
ations, rendering them dark like the medicine, and then in less 
frequent doses answers a good purpose. If the stools are 
light or clay-colored, Leptandrin and Geraniin are the appro- 
priate remedies, or small doses of the "White Liquid Physic 
may be given. In other cases the Sub-nitrate of Bismuth 
may be administered with the most marked advantage, 
especially if there is a tendency to dysentery, or tenesmus 
attending the discharges. At other times the common 
vegetable astringents may be used as in cases of common 



Cholera Infantum. 283 

diarrhoea. If the skin is harsh and dry, I administer Tincture 
of Aconite, gtt. xx, to Water, 3iv; in doses of a teaspoonful 
every hour, until the surface becomes moist and natural; 
and then follow with Quinia in doses of one grain every 
two hours, until two or three doses are taken. 

In chronic cholera infantum the same means are resorted to 
to check the vomiting. I give preference to the infusion of 
Compound Powder of Rhubarb, or of Peach-tree bark. We 
do not expect to arrest it at once ; sometimes two or three 
days, or a week, are required for that purpose. The first 
named agent, or the Syrup of Rhubarb and Potassa, given in 
teaspoonful doses every hour until the operations resemble the 
medicine in color, frequently answers an admirable purpose. 
The Epilobium is an agent I value highly in this disease, 
though not speedy in its action. I direct two drachms to 
one-third of a teacupful of boiling water, when cold strained, 
two teaspoonfuls of Brandy added, sweetened, and given in 
doses of a teaspoonful an hour. The Bismuth is excellent in 
some cases, as before named, and when there is torpor of the 
liver, as manifested by the light-colored discharges, the Lep- 
tandrin should be associated with all other treatment. 

In cases where there is any evidence of periodicity, or where 
there is a hard pulse or dry skin, Quinia is one of the most 
efficient remedies. It may be given in doses of one grain 
every two or three hours, until two or three doses are taken 
daily. In some cases it has arrested the nausea and diarrhoea 
when all other means had failed. It may be associated with 
the Hydrastin, in some cases, with advantage. If there is 
tendency to disease of the liver, I prefer small doses of Bella- 
donna and Aconite, alternated, or minute doses of Nux Vomica, 
ten drops to Hve ounces of water; and a teaspoonful every two 
or three hours would be as large as would be useful. 

The bath is an important agency in the treatment; it may 
be used cold, tepid or warm, according to the indications, and 
may be medicated by the addition of Salt, Bi-carbonate of 
Potassa, Capsicum or a decoction of bitter agents. The food 
will vary in different cases. If the child nurses, it may be 
restricted to the mother's milk, or if this disagrees, cow's milk 
will sometimes be appropriate; in other cases, farina, sago, 
etc., seems to answer best ; but frequently I have seen the best 
results from gratifying the child's appetite for meat, especially 
fat bacon, ham, dried beef, beef suet, etc. ; fatty matters, when 



284 The Eclectic Practice of Medicine. 

they agree with the stomach, answer an admirable purpose. 
Stimulants ma}' he employed, as the Brandy with Epilobium, 
already referred to, but the best is undoubtedly Catawba Wine, 
which sometimes seems to act as both food and medicine. 



TABES MESENTERICA. 

Tuberculous disease of the intestinal canal is most usually 
met with in childhood, though occasional cases will be seen 
even up to the age of twenty-five. It occurs only in those 
constitutions which we have before referred to as being tuber- 
culous, and where, if the irritation had been of the lungs 
instead of the bowels, it would have been phthisis. 

The pathology of the disease is well described by Habershon : 
"In disease of the mesenteric glands, a low organized product 
is effused into the glands themselves, probably because the 
chyliferous ducts become entirely obliterated, and the struc- 
ture of the gland destroyed. Their extensive disease pre- 
vents the absorption of chyle into the system. The glands 
share the disease in various stages and gradations; in some, 
but scanty abnormal product is found, in others the whole 
gland is destroyed and very much enlarged, constituting a 
whitish mass, the size of a pigeon's or hen's egg. The effused 
product consists of granular blastema, and imperfectly devel- 
oped cells. The swollen and injected state of the glands less 
affected, appears to indicate that inflammation or hyperemia 
is associated with the disease. The increase takes place by 
additions at the periphery of that already deposited, and 
degeneration occurs in the center from the scanty supply of 
nourishment afforded to the central part. The gland some- 
times appears to be enveloped by a firm, fibrinous cyst, which 
consists of inflammatory product better organized, having 
assumed the character of fibrous tissue, while the center con- 
sists of calcareous deposit, the albuminous portion having been 
absorbed, and the organic only left. Degeneration of another 
character, however, takes place in the effused product, it is 
converted into a mass of granular molecules and highly refract- 
ing particles, constituting small, cheesy tubercles of a yellow 
color, or a softened and semi-diffluent mass. The lacteals 
between the glands become enlarged and distended with simi- 
lar strumous product, or we can trace the distended ducts to 



Tabes Mesenteric. 285 

the intestine, where they ramify on its surface, and at this 
part we generally find a cluster of tubercles and ulceration of 
the mucous membrane." 

Symptoms. — In children it is usually preceded by diarrhoea 
and gradually increasing prostration. The appetite is usually 
good, sometimes ravenous, but patient receives no apparent 
benefit. The bowels are sometimes tumid, hot and tender, 
at others, very much shrunken; the evacuations consisting of 
a thin mucus, greenish, and frequently resembling the washings 
of meat. The countenance is contracted and pinched, the eyes 
set far back in the head, and the skin peculiarly dry, wrinkled 
and sallow, giving the child a prematurely aged appearance. 
It is restless, irritable and fretful, and presents many of the 
symptoms of cholera infantum. 

In the adult there may or may not be diarrhoea, frequently 
an alternation of diarrhoea and constipation, and sometimes 
severe pain. There is a marked marasmus, increasing day by 
day, though the appetite may be good, and the digestion 
seemingly well performed. The patient has an anxious expres- 
sion of countenance, a sallow, wrinkled skin, contracted abdo- 
men, and is uneasy, restless and irritable. In the latter stage 
diarrhoea sometimes sets in, and carries the patient off quickly, 
or disease of the brain or lungs, comes on to assist the tabes. 
In both cases the enlarged mesenteric glands can frequently 
be felt through the abdominal wall. 

Diagnosis. — Tabes mesenterica is diagnosed with difficulty. 
The principal symptoms leading us to believe in strumous dis- 
ease of the mesentery are: the continuance of a good appetite, 
and seemingly good digestion, with continually increasing 
loss of strength, and flesh, and the evidence of disordered 
bowels, and in the latter stages feeling the enlarged mesente- 
ric glands through the abdominal walls. It will be seen that 
our diagnosis will have to be made principally by exclusion, a 
very common method, and possibly more correct than by 
direct symptoms. 

Prognosis. — The prognosis in well-marked cases of this dis- 
ease is exceedingly unfavorable, as much so as any disease we 
are called to treat. In the earlier stages its progress may be 
arrested as it may also occasionally in the latter. 

Treatment. — In the case of children but little additional can 
be named to the treatment of cholera infantum, which is 
adapted to this disease. The use of Cod-liver Oil, when it 



286 The Eclectic Practice of Medicine. 

can be taken without nausea or deranging the bowels, some- 
times proves beneficial, as does also the bath of the same, or 
free innervation with almost any fatty matter. Opium, in the 
form of the Diaphoretic Powder, may be used to quiet rest- 
lessness, and Iodide of Potassium and Quinia given to promote 
absorption and keep up the strength. As an external appli- 
cation, nothing is better than one part of Turpentine to four 
of Sweet Oil applied to the entire surface of the abdomen. 

The treatment of the adult will not vary much from this, 
the continuous use of the Salts of Potassa in minute doses, 
with very small doses of Leptandrin, Podophyllin, and Macro- 
tin, triturated with white Sugar, and. not in sufficient doses to 
affect the bowels, is the most serviceable treatment. The 
employment of the alkaline sponge bath with friction, moder- 
ate exercise in the open air, and all measures that will improve 
the general health of the patient increase his chances. 



ILEUS. 



Obstruction of the bowels is not of very frequent occur- 
rence. It may arise from various causes, among which may 
be enumerated: "1, From bands of adhesion, the results of 
inflammatory action; 2, From congenital intestinal pouch 
becoming adherent; 3, From the appendix cseci assuming a 
fixed and adherent position; 4, From the twisting of the 
intestine upon its own axis, upon the mesentery, or upon 
other coils of intestine; 5, From tumors developed in the 
mesentery leading to constriction; 6, From intussusception; 
7, From cancerous disease of the intestine, 8, From contrac- 
tion of cicatrices, as after dysentery or fever ; 9, From enter- 
itis or peritonitis ; 10, From impaction of faeces, or of foreign 
bodies, as gall-stones, etc. ; 11, Obscure forms of hernia, as 
into the obturator foramen, etc. ; 12, Prolapus-ani and 
inflamed hemorrhoids; 13, Abdominal or pelvic tumors." — 
(Habershon). Some of these causes are readily determined, 
and may be excluded from the subject, as enteritis, peritoni- 
tis, prolapsus-ani, inflamed hemorrhoids and abdominal or 
pelvic tumors. Again, it has been contended by some authors 
that all the symptoms found in these cases may be produced 
by a spasmodic state of the intestine, no strangulation or 
cause of obstruction being detected after death. 



Ileus. 287 

Symptoms. — In the early stage of the affection* the patient 
is obstinately constipated, and complains of an uneasy sensa- 
tion at the part where the obstruction exists, being sometimes 
able to place the hand directly on the part. In a longer or 
shorter time he complains of a twisting or violent pain about 
the umbilicus, without tenderness on pressure, in fact, fre- 
quently relieved by it. Nausea comes on, with frequent retch- 
ings, vomiting of the contents of the stomach, then of bile, 
of and finally feculent matters. The abdomen becomes very 
much distended with gas, is tense and tender, the countenance 
shrunk and anxious, the extremities cold, with frequently 
cold, clammy perspiration, hiccough, and gradual failure of 
vital power. 

The disease pursues a variable course, sometimes the suffer- 
ing is extreme at the commencement, and all the worst symp- 
toms above named appear in twenty-four or forty-eight hours; 
in others, the disease will not terminate fatally under six or 
seven days; and in some cases, the large intestine being the 
seat of the obstruction, it may last for three or four weeks. 

Diagnosis. — Much difficulty is experienced in detecting the 
character of these cases, as the symptoms at first are none of 
them distinctive. If of sudden occurrence, as when the 
patient feels a sudden, severe colicky pain when straining at 
stool, becoming more and more severe, and attended with ten- 
esmus and constant desire to go to stool, but unable to pass 
anything from the bowels, we have a tolerably plain case. In 
other cases, we are led to believe that there is intestinal 
obstruction by the continuance of the constipation, sufficient 
means having been used for its removal, by the fixed location 
of the severe pain, and the constant nausea and marked pros- 
tration, At a later stage, the continuance of all the above 
symptoms, and the appearance of stercoraceous vomiting is 
positive evidence. If the patient has had peritonitis, We have 
reasonable ground to conclude that it results from adhesions. 
Tumors are likely to have given rise to previous uneasiness, 
and to be so developed as to be diagnosed on examination. 
Cancer will have been of long duration, and given rise to dis- 
turbance of the bowels, and the ileus of slow formation. 
Impaction of feces may sometimes be determined by the 
hard, irregular tumor that presents, and its sudden appear- 
ance. Obscure hernia by its location and the circumscribed 
character of the pain. 



288 The Eclectic Practice op Medicine. 

Prognosis. — The prognosis in these affections is unfavorable, 
though many recover. If there is continued increase in the 
severity of the symptoms, the nausea and vomiting being 
intense and persistent, and especially of stercoreaceous mate- 
rial, with great prostration and anxiety, the prospect is very 
poor. If, however, the bowels are moved, the pain being mit- 
igated, the patient will recover. In some cases of intussuscep- 
tion, when the symptoms are very severe, the patient still 
retains his strength, the nausea abates somewhat, and after 
two, three or four weeks of suffering, a portion of the intus- 
suscepted bowel is discharged, and the patient recovers. So 
many of these cases have occurred, that we would not des- 
pair, even after having employed all the means recommended 
without success, for nature will sometimes step in, and thus 
save the life of the person. 

Treatment. — In almost all cases purgatives will have been 
thoroughly tried, before we are called, so that we will not 
have to regret the giving them as one of ours; still, cases 
will undoubtedly occur, in which the symptoms will be so 
obscure that we will administer them ourselves, to the 
great detriment of the patient. In all cases, the admin- 
istration of Opium and an infusion of Dioscorea, or Dioseorin 
in sufficient quantity to relieve the pain, will be all the inter- 
nal medicine usually of use. The nausea must be quieted as 
much as possible, by the use of the means heretofore named: 
an infusion of Compound Powder of Bhubarb, Peach-tree 
bark, Sub-nitrate of Bismuth, Ice, Morphia, etc., and the 
employment of counter-irritation to the epigastrium. The 
association of Chloroform, Sulphuric ^Ether, or Tincture of 
Gelseminum will be advantageous in some cases, the two first 
especially in case of tympanitis. 

To relieve the obstruction, large quantities of fluid, thin 
gruel is as good as anything, should be thrown up the bowel 
with a pump syringe. As much as from half to one gallon 
may be thus used, completely distending the large intestine. 
This may be repeated several times per day; or, what is 
deemed even better than this, the introduction of air by 
means of an air-pump, until the larger intestine was distended 
to its full extent. Change of position is sometimes advan- 
tageous, at others hurtful, and the same be said of the sudden 
application of cold water. Great relief may sometimes be 



Colic. 289 

given by the use of the hot sitz bath, and occasionally by the 
use of hot fomentations to the abdomen. 

The question of surgical interference in bad cases, becomes 
one of anxious consideration, as in some cases the obstruction 
is of such character as that it might thus be relieved with the 
greatest facility. Mr. Hilton has resorted to this mode of 
relief with success, but others have signally failed. When it 
can be determined that the obstruction is of the large intes- 
tine, the operation for artificial anus, offers the best chance 
for success. If the means first named does not prove success- 
ful, we endeavor to prolong the patient's life, hoping that 
nature will step in and remove the obstruction. "We thus use 
stimulants in small quantities, and nutritious enemata, and 
such means as will relieve the sufferings of the patient as 
much as possible. 



COLIC. 



The general features of colic are griping pains in the bowels 
of a more or less constant character, constipation, and absence 
of inflammatory or febrile symptoms. It may be dependent 
upon various causes, as acrid ingesta, irritating secretions, 
gaseous accumulations, spasmodic contraction of the muscular 
coat from irritation of the sympathetic and spinal nervous 
systems, structural disease of the intestinal canal, and disease 
of the blood. We may describe the disease as consisting of 
three forms — common or wind colic — bilious colic and colica 
pictonum or lead colic. 

Symptoms. — The common form of colic is produced most 
frequently from irritating ingesta, or acrid secretions. It 
commences with a severe griping pain in the region of the 
umbilicus, though somewhat wandering in its character, 
changing its position from one side to the other, and from 
above to the lower portions of the abdomen. It is not con- 
stant, but remittent, giving the patient a moment's ease, then 
recurring with increased severitv. In some cases it seems to 
be confined to the stomach, as if it was contracted upon itself 
(cramps of the stomach), but more frequently involving the 
entire intestinal canal. 

There is no tenderness on pressure, but frequently relief is 
afforded by it; the skin is cool, the pulse regular and not 
increased in frequency, and there are no symptoms of febrile 
19 



290 The Eclectic Practice of Medicine. 

action. The bowels are usually constipated, though if pro- 
duced by irritant ingesta, there may be watery evacuations 
from the bowels. 

It generally lasts but a few hours, though if not properly 
treated, it sometimes becomes very severe. 

Treatment. — The treatment is simple: if the pain is con- 
fined principally to the stomach, or upper portion of the 
abdomen, and we have the evidence that the patient has been 
lately eating unripe fruit or other articles difficult of digestion, 
we would immediately give an emetic. Thirty grains of 
Ipecacuanha in warm water, will answer the purpose admira- 
bly, or we may use a teaspoonful of Mustard in half a 
tumblerful of warm water, or give an infusion of Compound 
Powder of Lobelia. In other cases, the most effectual and 
quickest remedy, is, the Compound Powder of Jalap and 
Senna in doses of twenty grains every hour, until the pain is 
relieved; or, if the patient objects to taking it by the mouth, 
two drachms mixed with warm water, and used as an enema, 
will answer the purpose admirably. In lieu of this, almost 
any of the Aromatics may be employed, or equal parts of 
Compound Tincture of Lavender, and Syrup of Rhubarb and 
Potassa; or, a Tincture of the Oil of Anise, of Peppermint, or 
of Cajeput; or, a teaspoonful of ground Pepper, Tincture of 
Camphor, etc. A sinapism applied to the abdomen fre- 
quently gives relief, though I prefer a towel wrung out of 
cold water. 



BILIOUS COLIC. 

Bilious colic is doubtless dependent upon an irritation of 
the mucous membrane of the intestinal canal, with vitiated 
secretions, which irritation induces spasmodic contraction of 
the muscular coat. We have to determine whether the 
irritation is dependent upon the acrid character of the secre- 
tions, or, whether the change in the secretions is not owing 
to the irritation of the mucous membrane. The name bilious 
is derived from the fact that the vomiting that so generally 
attends the disease, is to some considerable extent mixed 
with bile. 

Symptoms. — Very frequently the attack of colic is preceded 
by symptoms of irritation and imperfect digestion. The 
tongue has been coated at the base, the mouth is clammy 



Bilious Colic. 291 

and lias a bad taste, the head feels bad, the skin dry ; bowels 
constipated, and more or less languor of the system. 

When the disease commences, there are severe griping pains 
in the bowels, more severe than in the preceding case, and not 
exhibiting the same remissions. The abdomen is more or 
less tumid, with marked tension or hardness ; pressure elicits 
some tenderness, but this usually passes off, if it is continued, 
when it frequently gives relief. Nausea or vomiting fre- 
quently make their appearance in the early part of the 
disease, though sometimes not until the last. The retchings 
are violent and painful, and often the contents of the stomach 
are thrown up, consist of a greenish, or yellowish, acrid 
bilious material. The pulse is slightly accelerated and full 
from the commencement, and the patient nervous and 
irritable. 

As the disease progresses the pain becomes more severe, and 
is not unfrequently attended with a desire to evacuate the 
bowels, which is found to be impossible, or, if anything passes 
it is small in quantity and scybalous. The abdomen becomes 
harder and pressure causes pain, the pulse is accelerated, the 
countenance has an anxious expression, the skin is harsh, the 
extremities cold, and the patient extremely restless. The 
strength gradually gives way to the severe suffering, the 
disease lasting from one to three or four, or in some cases, 
seven or eight days. 

Diagnosis. — Bilious colic is diagnosed by the intensity and 
continuance of the pain, the hard and tumid abdomen, nausea 
and vomiting, acceleration of pulse, and harsh, dry skin. 

Prognosis. — Though attended with much suffering, yet a 
favorable result may be looked for in a large majority of cases. 
A subsidence of the pain, the bowels being soon moved, are 
the most favorable indications. 

Post Mortem Examination. — No lesion has been found to 
account for the severity of the disease. In some cases there 
was slight congestion of the intestines, with evidence of spas- 
modic contraction, absence of any material within this por- 
tion, or sometimes masses of scybalous faeces, almost or quite 
blocking up the cavity. 

Treatment. — We do not employ a great many remedies in 
this disease, but what we do use, seems to answer the purpose 
well. If the Dioscorea could be obtained, I should want no 
other medicine; make a strong infusion, and give it in table- 



292 The Eclectic Practice of Medicine. 

spoonful doses every ten minutes until the pain ceases ; or the 
Dioscorin or the Tincture may be employed for the same 
purpose, but are not as efficient. If this could not be obtained, 
I would strongly recommend the Compound Powder of Jalap 
and Senna, in doses of ten grains, every fifteen minutes, until 
the bowels are moved. There is no fear of giving too much, 
as it will be rejected by the stomach, a considerable portion 
being thrown up at each time, when the nausea is great. To 
assist its action in severe cases, I use the same agent as an 
enema, mixed with warm water. 

Other remedies may be used, but without any permanent 
advantage, so far as I could ever discover; Chloroform with 
Glycerin will frequently quiet the pain for the time being, 
and may be used for this purpose, whilst we are waiting for 
the action of other medicines, as may also some of the aromatic 
stimulants. The Epilobium in infusion has been very highly 
recommended, but I have not yet had an opportunity to try it. 

The warm bath, or the vapor bath, give great relief, and 
materially assist the action of the other remedies. Or, fomen- 
tations of hops or bitter herbs, or, what is very servicable, the 
Polygonum may be employed in place of the* bath. Cups 
either dry or wet are sometimes useful, but I have never seen 
any good results from other means of counter-irritation, except 
over the epigastrium, to relieve vomiting. 

If the nausea and vomiting are so persistent as to prevent 
the employment of the remedies first named to advantage, 
I would advise the use of an emetic of the Comp. Powder of 
Lobelia, with copious draughts of a warm infusion of Penny- 
royal or Sage, and given to produce relaxation and copious 
emesis. If inflammation of the bowels results, as is some- 
times the case, it should be treated by the use of special 
sedatives, Belladonna, alkaline diuretics, cups to the abdomen, 
and the thorough use of the warm bath. 



COLICA PICTOKUM. 
Lead colic most generally occurs in persons who work in 
lead, as workmen in paint manufactories, painters, plumbers, 
type founders, etc., and is the result of a continued absorption 
of the mineral for a considerable period of time. Some per- 
sons are peculiarly susceptible to the poison of lead, and in 



COLICA PlCTONUM. 293 

such cases we may find it caused by sleeping in a recently 
painted room, the medicinal administration of lead, and by 
using water passing through lead pipes. 

Cases of chronic lead poisoning are observed in which there 
is no derangement of the bowels, the patient is very sallow and 
anaemic, muscular development diminished, the appetite and 
digestion impaired, and more or less paralysis, the most com- 
mon form of which is is a peculiar form of dropping of the 
wrists. The most distinctive feature in all cases of lead 
poisoning is a blue line on the edges of the gums, which may 
be taken as a guarantee of lead absorption. 

Symptoms. — Lead colic commences with an obscure pain in 
the abdomen, the bowels being costive and hard, and some- 
times knotted to the touch. As it continues it becomes so 
severe that the patient screams with agony; at first confined 
to the region above the umbilicus, and seeming to shoot from 
one hypochondria to the other, it gradually extends until it 
affects the entire abdomen. In the severe cases it extends to 
the back, the upper extremities, the hips, thighs and legs, until 
it sometimes seems that no part of the body is free from pain. 
The abdominal walls are tense and hard, sometimes knotted, 
and the umbilicus is drawn inwards. The bowels are not 
tender to pressure, neither does it alleviate the pain, as in 
some other forms of colic. The patient is frequently troubled 
with nausea and vomiting, the material thrown off the 
stomach being a slimy fluid more or less mixed with acrid 
bile. The tongue is pale, broad and flabby, and its move- 
ments controlled with difficulty, the skin soft and moist, the 
pulse not at first affected, but when the disease is long- 
continued and severe it becomes soft, feeble and increased 
in frequency. The bowels are obstinately constipated, if 
anything passes, it is in hard scybalous masses, with a brown- 
ish water; the sphincters seem to be sometimes so contracted 
that neither urine or faeces can be passed, and it is with the 
greatest difficulty that we can introduce the clyster pipe. The 
duration of the disease is variable, terminating in a majority of 
eases between the second and thirteenth day of the treatment. 

Diagnosis. — The diagnosis is in some cases difficult, though 
in others the symptoms above named are so well defined as 
not to be mistaken. The fact of the patient's being a worker 
in lead, or having been exposed to it in an unusual manner, is 
an aid to diagnosis. If there is the blue and livid line on the 



294 The Eclectic Practice of Medicine. 

gums, or a dropping of the wrists, we are assured we have a 
case of lead poisoning. 

Prognosis. — The prognosis is favorable in a large majority 
of cases, though the disease may last for some time. 

Post-Mortem Examination. — Lead eolic generally proves 
fatal from its complications, the most frequent being of the 
nervous system. Most authors claim that no lesion of the 
intestinal canal can be detected on dissection, the bowels being 
perfectly natural throughout, though the muscular coat is 
pale and wasted. One, Dr. Hazen, claims that contraction 
of the colon and caecum existed in all cases that he examined. 

Treatment. — The first object of treatment is to mitigate the 
intense pain, and open the bowels, after which means to 
remove the lead should be immediately used. Among the 
most efficient means for the relief of pain, is the administra- 
tion of Chloroform in doses of from twenty to thirty drops 
every half hour or hour ; it may be administered in mucilage, 
water, rectified spirits, or what is preferable to all, Glyceriu. 
I usually order it in the following manner : #, Chloroform, 
3ss ; Glycerin, 3ij, shake well and give a teaspoonful as often 
as required. If this can not be obtained, or fails, Opium, Bel- 
ladona, or Hyoscyamus may be used in full doses in its stead. 
With this, Alum in doses of fifteen grains every two hours, 
or Iodide of Potassium, in doses of two or three grains every 
hour, as antidotes to the poison. 

To open the bowels, I prefer the use of enemata of Com- 
pound Powder of Jalap and Senna, or the same may be used 
internally, or a pill containing from half to one drop of Croton 
Oil, is recommended in bad cases ; if the last were given, I 
should make the mass of Extract of Hyoscyamus, two to five 
grains. Sulphate of Magnesia has been used for the same pur- 
pose and is highly recommended, as is also the White Liquid 
Physic, heretofore named. 

As a local application, Chloroform applied to the abdomen 
is one of the most efficient ; in using it, drop fifteen or twenty 
drops on a wet cloth, and apply for a few minutes and repeat. 
Hot fomentations have been used, but without much benefit, 
as has also the cold water bandage. A cataplasm of Tobacco 
is highly recommended, and I have no doubt will prove useful. 
I prefer the warm bath to other means. If there are no 
facilities for giving an entire bath, a large wash-tub filled with 
water as hot as can be borne, the patient sitting in it, answers 



Disease of the Cecum. 295 

a good purpose. A bath, containing the Sulphide of Potas- 
sium, in the proportion of four ounces to thirty gallons of 
water, is recommended for its specific influence. The use of 
Electricity, I know to be beneficial, not only in relieving the 
pain, but in the form of a galvanic bath, in removing the 
metal from the system. 



DISEASE OF THE CJECUM. 

The caecum is to some extent beyond the direct current of 
the intestinal contents, and may thus suffer with derangements 
different from other portions. Situate below the ileo-caecal 
valve, it would be more likely to suffer from impaction of 
faeces, and on account of its dependent position is likely to 
be the depot for foreign substances. 

Abnormal distension, is sometimes the consequence of 
obstruction of the colon, but more frequently of an atony 
of the caecum itself. 

The distension may be of hardened, or impacted faeces, or of 
faeces and of flatus. Pain in the right iliac region of a colicky 
nature, and sometimes quite severe is the result, and from 
pressure on the genito-crural and dorsal nerves, there is occa- 
sionally quite severe pain in the hip, in the groin, testicles, 
and sometimes down the thigh in the course of the saphenous 
nerves. These pains may or may not be constant, and 
sometimes last for several days. They are relieved by the 
employment of cathartics that act upon the lower intestines 
as the Aloetic or Anti-dyspeptic Pill. 

Inflammation. — Inflammation of the caecum may result from 
the lodgment of irritating material within it, or from its 
mpaction with faeces. The symptoms are, at first, a dull 
obscure pain and weight in the right iliac region, with 
derangement of the boweb, generally constipation, though 
sometimes diarrhoea. 

As the disease continues, the pain becomes more severe, is 
continuous, and increased by pressure ; frequently it radiates 
to the hip, groin and testicle. The appetite is now much 
impaired, the tongue coated, the skin dry and harsh, and 
the pulse excited. A tumor is now usually perceptible on 
examination, though the tenderness is so great, that it 
is difficult to make an accurate one. Three or four days pass 
o5 in this way, there is sometimes a general peritonitis with 



296 The Eclectic Practice of Medicine. 

acute tenderness and lancinating pain, anxious countenance, 
cold extremities, a feeble and frequent pulse, and death in a 
short time. Or, the inflammation will result in the deposit 
of plastic lymph, agglutinating the parts together, suppuration 
occurs, finally opening on the surface, and discharging both 
the contents of the abscess and the bowels. In these cases 
the disease may be of many days, or even weeks duration, 
and attended with symptoms of great prostration. 

Diagnosis. — The diagnosis is very difficult, but we are 
guided by the location of the disease, the sudden appearance 
of the enlargement, the character of the pain, and the dis- 
turbance of the function of the bowels. 

Prognosis. — The prognosis is favorable in most cases, as 
the inflammation may be removed with considerable ease, in 
the early stage of the affection. If peritonitis results, or there 
is great distension from impaction of hardened faeces, the 
prognosis is unfavorable. 

Treatment. — The administration of the special sedatives, 
with a diaphoretic, as the Compound Powder of Ipecac and 
Opium, should be continued from the commencement until 
the inflammation has subsided. Cups or Leeches should be 
applied to the seat of the pain, and followed by hot fomenta- 
tions ; or if these should seem to increase the pain, cold 
applications. Drastic purgatives should be avoided, as they 
would increase the disease by the violent action they would 
set up. In their stead equal parts of Bi-tartrate of Potassa, 
and Compound Powder of Jalap and Senna, might be used 
in small doses, or the last named agent might be used as an 
enema. I have employed the Epilobium in one case of this 
disease, and seemingly with marked benefit, and would recom- 
mend it, in addition to the means already named. 

"If there be evidence of suppuration, or of fsecal abcess, 
whilst we endeavor to limit the action by slight counter-irrita- 
tants, by occasional local depletion, we must sustain the 
power of the patient by Quinia, by support and by tonic 
treatment. Opium is often of great value in its anodyne and 
narcotic action, in checking peristaltic action, relieving pain, 
soothing an over-excited nervous system, the excitement of 
exhaustion, and often procuring refreshing sleep. "When there 
is collapse and tympanitis, evincing perforation of the appen- 
dix or intestine, nothing should induce us to administer any 
aperient, or induce action from the bowels. We desire to 



Dysentery. 297 

limit the mischief produced by checking the movement of the 
intestines, and to diminish inflammatory action, by soothing 
the nervous system; Opium must be given freely, and only a 
small quantity of food administered." — (Habershon.) 



DYSENTERY. 

Inflammation of the large intestines is among the most fre- 
quent diseases of the digestive apparatus. It occurs at all 
ages, and in all climates, though it is more frequent and severe 
in southern latitudes. In this country it usually prevails to 
the greatest extent during the fall months, though sometimes 
met with during the summer. Occasionally it becomes epi- 
demic, and is extremely severe, and at these times it has been 
claimed by some that it was contagious. 

The causes of dysentery are chiefly sudden atmospheric 
changes, or a high range of temperature following a wet and 
cold season, over-exertion and arrest of secretion, the accumu- 
lation of morbid secretions in the intestinal canal, miasmata, 
and in the epidemic form a zymotic poison in the atmosphere. 

Symptoms. — Dysentery may very properly be divided into 
the sporadic and epidemic, and the last we will find assuming 
many different characters. Sporadic dysentery is sometimes 
preceded by constipation, but more frequently by slight diar^- 
rhcea. The patient has small mucus or bloody evacuations 
from the bowels, attended with tormina and tenesmus. At 
first they are not very frequent, but after a time they recur as 
often as say five to fifteen minutes. Sometimes the disease 
commences with a well-marked chill, but at others none is 
noticed. More or less febrile action will be found in all cases, 
the pulse hard and increased in frequency, the skin dry and 
harsh, the urine scanty and high-colored, and considerable 
restlessness and uneasiness. Pressure over the colon will usu- 
ally detect a soreness in some part of its course. 

Most generally in this form of the disease, the upper bowels 
are obstinately constipated, as the discharges consist entirely 
of mucus, mucus and blood, or almost pure blood ; sometimes, 
however, it assumes the character of dysenteric-diarrhoea, the 
operations having more or less feculent material mixed with 
them, or the dysenteric discharges being alternated with diar- 
rhceal. Day by day we observe the disease becoming severer 



298 The Eclectic Practice of Medicine. 

unless controlled by appropriate treatment, until at last the 
patient is very much reduced, the symptoms assuming the 
character of those of the epidemic form of the disease. 

Epidemic dysentery occurs in two principal forms, though 
there are various gradations: these are, cases with obstinate 
constipation of the small intestines, with an active grade of 
fever, and cases where there is an irritability of the intestinal 
tract, with a low or asthenic fever. 

In the first form, the disease almost always commences with 
a well-marked rigor or chill, followed by high febrile action. 
The discharges from the bowels soon become frequent, are 
preceded and attended by tormina, the pains being of a severe 
cutting character. The tenesmus or desire to evacuate the 
bowels is almost constant, and is very distressing during the 
operation ; it seeming to the patient that the desire for an 
evacuation would never cease. No rest can be obtained during 
this condition, and as a natural consequence the patient is very 
fretful and uneasy. The discharges from the bowels are some- 
times pure mucus, at others mucus mixed with blood, and again 
seemingly almost pure blood, in each case the material being 
unchanged, not dirty or discolored as in the next form of the 
disease. 

As it continues we find that day by day the disease becomes 
seemingly more severe. The fever is remittent or continued, 
and very severe, the skin being dry and parched, the pulse 
hard and frequent, pain in the head and back, the tongue 
coated, a bad taste in the mouth and loss of appetite, the 
urine scanty, sometimes passed with difficulty, and anxiety and 
uneasiness from the almost total want of sleep from the com- 
mencement of the disease. Up to the sixth or seventh day 
the symptoms will be thus acute, but after that, we find the 
fever assuming a typhoid type, and the discharges from the 
bowels become discolored and offensive as in the next variety. 

The second form frequently commences as above described, 
the fever following the chill or rigor being acute. The dis- 
charges from the bowels are small, and composed of mucus 
and blood, and attended with an intense tormina and tenes- 
mus. But in the progress of the disease it is found that any 
cathartic will start the small intestines into action, and we 
have the more or less offensive feculent matter passed with the 
dysenteric discharges, or alternately with them. When this 
occurs, the typhoid symptoms described below soon make 



Dysentery. 299 

their appearance. In other cases the discharges are senii- 
diarrhoeal at the commencement, and we find this irritability 
of the small intestines and sometimes of the stomach continu- 
ing throughout the progress of the disease. This feature of 
the disease must be noticed, for if we should give in this case 
a cathartic to increase secretion from the liver, and open the 
small intestines, we would many times set up an irritation that 
we would find it impossible to quiet. Dr. Copland describes 
the symptoms of typhoid dysentery as follows : " The patient 
complains at first of general depression, vertigo, violent head- 
ache, increased sensibility to light, pains in the limbs and 
joints, and of gripings and purgings, followed by anxiety at 
the prsecordia, stupor, foul clammy tongue and mouth, which 
soon becomes dry and covered by a brownish coating, a pene- 
trating offensive odor of the breath, and intense thirst. The 
pulse at first is very quick and small, and afterward weak and 
irregular. The stools are, from the commencement, very fre- 
quent, in small quantity, preceded by tormina and tenesmus, 
and glairy or serous, and contain more or less dark blood. 
The urine is scanty, thick, and dark colored. About the 
fourth or sixth day, a milliary eruption or petechia sometimes 
appear about the neck, breast, arms, and abdomen, and occa- 
sionally epistaxis occurs, between the fourth and eighth days, 
in young and robust subjects, but without becoming critical. 
The intensity of the tormina and tenesmus generally dimin- 
ishes with the progress of the disease, and often about the 
ninth or eleventh day is replaced by a colliquative diarrhoea. 
The stupor is now attended by delirium; the soft solids waste 
and become flaccid; the surface assumes a dirty hue and an 
offensive penetrating odor issues from the body and evacua- 
tions. If not ameliorated or arrested in its progress, this 
form terminates fatally from the eighth to the twenty- fourth 
day." 

Many of these symptoms make their appearance in the last 
stages of epidemic dysentery, and we see cases that run their 
course as just described. We again find others much more 
malignant. By the second, or third, or fourth day, the coun- 
tenance is sunk, anxious, and cadaveric, the tongue covered 
with an offensive brown fur, sordes on the teeth, fetor of 
breath, a small, feeble and frequent pulse, great depression of 
the nervous system, and want of power to control the volun- 
tary muscles. The evacuations, which were at first of a dirty 



300 The Eclectic Practice op Medicine. 

mucus, with more or less dark grumous blood, sometimes 
alternated by a very foetid feculent matter, now become red- 
dish and slimy, resembling the washings of meat, or prune 
juice, and excessively foetid and cadaverous. The tormina and 
tenesmus, which at first were severe, abates, and sometimes the 
stools are passed involuntarily, and attended with sinking and 
tendency to syncope. Soon delirium ensues, the patient lies 
on the back, sinks down towards the foot of the bed, picks at 
the bed-clothes, and after lasting in this condition longer than 
it would seem possible, finally sinks. 

Diagnosis. — Dysentery is one the most easily recognized of 
diseases. The small mucous or bloody evacuations, the tormina 
and pain preceding and attending the operations, and the ten- 
esmus or feeding as if more should pass, straining to effect it, 
are so distinctive as to render it almost impossible to make a 
mistake. The only conditions with which it could be con- 
founded would be disease of the rectum from hemorrhoids, 
fissure, stricture, or sympathetic irritation from the bladder or 
vagina in front. But these are not attended with the consti- 
tutional disturbance of dysentery, and may be thus recognized. 

Prognosis. — The prognosis will depend to a considerable 
extent upon whether the disease is sporadic or epidemic, and 
whether it is an acute inflammation with vigorous reaction, or 
a typhoid disease. Sporadic dysentery is very easily treated, 
and not having seen any other, practititioners sometimes get 
the idea that it is an affection very easily managed, and by 
simple remedies, which notion is not generally lost until they 
lose several patients in an epidemic, and thus have to study 
the disease. That form of the affection in which there is 
manifest irritability of the small intestines, or the one described 
as typhoid dysentery, are most serious forms of disease, 
and require much care in their management. As a general 
rule, all the cases during an epidemic will closely resemble 
each other in their general features, so that after determining 
its character at first, we are not likely to make mistakes, espe- 
cially the fatal one of mistaking a typhoid for a sthenic disease. 

Post-Mortem Examination. — The appearance of the abdo- 
men and contents on dissection vary greatly. In some cases, 
on opening the abdominal wall, we find more or less of a 
dirty, turbid serum within the peritoneum, or the omentum 
agglutinated to the superficial convolutions of the intestines, 
and these feebly adherent to each other, from the effect of 



Dysentery. 301 

peritonitis. The small intestines rarely present more change 
than this, except more or less discoloration from softening 
and imbibition. The colon is sometimes displaced from 
elongation of the longitudinal fibres, in some parts thickened, 
others thinned, and frequently presenting singular constric- 
tions, as if the part had been tied with a ligature. On opening 
the intestine, the mucous membrane is seen to be variously 
discolored from a pale-grey to a greenish or violet color, and 
from a pale-red to a reddish-brown or black. Large portions 
of coagulable lymph are sometimes found partially adherent 
to the surface. At some points the mucous membrane seems 
thickened, and its epithelium detached so as to form a large 
irregular excoriation covered by the slimy cadaverous material 
which was being passed before death. At other times the 
ulcers are deeper, extending into the mucous membrane, 
through it to the muscular coat, or through this to the peri- 
toneum, having thus set up peritonitis in the latter stages of 
the disease, or in some cases having perforated the entire wall 
of the intestine. The ulcers may be numerous and small, or 
large and few in number, sometimes circumscribed and well- 
defined, at others irregular and sloughy. In some cases we 
find the intestine divested of considerable portions of its 
mucous membrane which has passed by stool during life. 

Treatment. — The treatment of the sporadic form of dysen- 
tery is usually quite simple. To overcome the atony of the 
small intestines, and stimulate the liver to action, we may 
give #, Podophyllin, gr. v; Leptandrin, gr. x; Bi-tartrate of 
Potassa, 3j ; triturate, make ten powders, of which one may 
be taken every three hours, until the bowels are acted upon ; 
or we may use the White Liquid Physic in doses of a table- 
spoonful every hour until the character of the operations are 
changed, or the Neutralizing Cordial may be used for the same 
purpose. 

The febrile action may be controlled, if high, by the use of 
the special sedatives, and a solution of Acetate of Potassa; the 
last being specially indicated if the patient has head-ache or 
pain in the back or limbs. 

As a local application, a sinapism followed by hot fomenta- 
tions gives great relief, or an Aconite and Chloroform liniment 
may be used, or cold applications, or in severe cases cups 
answer a better purpose. If the tormina and tenesmus is very 



302 The Eclectic Practice of Medicine. 

severe, the liot hip-bath is very useful, or in its stead we may 
sometimes use the wet bandage. 

Injections are considered by many as among the most valu- 
able means of treatment. The most common form of enema 
is Laudanum and Starch water, in the proportion of half a 
drachm of the first to an ounce of the second ; it should be care- 
fully administered after each operation, and retained if possi- 
ble. Glycerin and Opium answer a good purpose ; so does the 
Glycerin and Belladonna, used as an injection. Sometimes 
large injections answer a better purpose, and a pint or even 
quart of tepid infusion of Ulmus, or simple warm water, and 
in other cases, the large injection of cold water has been fol- 
lowed by like good results. 

The first form of epidemic dysentery may be treated in a 
similar manner to the above, though additional means are 
necessary. If there is any tendency to nausea, and there fre- 
quently is, I give an emetic of Ipecacuanha, in doses of ten 
grains, every ten minutes, until it acts thoroughly. I am not 
satisfied but that it would be much better to commence the 
treatment in this way in all cases. Following this I direct, 
#, Podophyllin, Opium, aa, gr. v; Leptandrin, gr. xx; M., and 
divide into ten powders, of which one may be taken every 
two hours, until the discharges are changed ; or, instead of 
this, the White Liquid Physic, as before recommended, will 
answer an admirable purpose. 

The febrile action must be moderated by special sedatives, 
as for remittent or continued fever, and as soon as indicated 
by the action of the sedative and cathartic, a solution of Ace- 
tate of Potassa. By the second da} T , we will usually have pro- 
duced such an impression on the fever as to permit the use of 
Quinia, which should be given to the extent of from twelve to 
fifteen grains, divided in three doses, and taken during the 
forenoon. It is just as important that this treatment should 
be assiduously pursued as it would be in a case of remittent 
fever ; and we frequently find the dysentery yielding easily 
when we have arrested the fever. 

The local applications may be the same as in the preceding 
form. The most efficient is the wet cups to almost the entire 
extent of the inflamed colon, determined by the tenderness on 
pressure, and followed by hot fomentations. Occasionally 
heat seems to aggravate the pain, and the cold water bandage 
then answers the best purpose. Nothing gives greater relief 



Dysentery. 303 

in some of the more severe cases, than the hot sitz bath used 
frequently through the day. The alkaline sponge bath should 
be used to assist in controlling the fever. 

Injections to relieve the irritability of the rectum should 
always be employed, unless, as in some rare cases, they are 
not tolerated. Laudanum and Starch water are the most gen- 
erally useful ; the greatest care is frequently necessary in their 
use, as if introduced so as to irritate the rectum, they will be 
immediately rejected, and instead of doing good will do harm. 
The large injection of cold or warm water will be found occa- 
sionally beneficial. In some cases a solution of Acetate of 
Lead, five or ten grains to the ounce of water will be retained 
when Opium is rejected. 

The second form of epidemic dysentery must be treated 
differently so far as the local inflammation is concerned. Here 
the administration of a cathartic will sometimes be followed 
by intense irritation of the small intestines, and very severe 
symptoms difficult of control. At first I direct the special 
sedatives, Aconite and Veratrum, as recommended in fever, 
and give half an ounce of Sweet Oil with two grains of Lep- 
tandrin every two hours, until the bowels have been evacuated 
once. In some cases the White Liquid Physic, but more fre- 
quently the Syrup of Rhubarb and Potassa may be used for 
the same purpose, as may also some of the milder laxatives. 
After having tried all the means recommended for this pur- 
pose, I am satisfied that pure Olive Oil is by far the best agent 
that can be used, as it stimulates the removal of irritating mat- 
ters from the intestine, and at the same time seems to soothe 
and quiet irritation. It may be repeated as often as it seems 
necessary to change the character of the discharges. 

Following this, I order one grain of Opium with two grains 
of Leptanclrin every three hours in the afternoon and evening, 
or sufficiently often to control the pain, reserving the forenoon 
for the administration of Quinia. Usually the continued 
administration of the sedatives, with the judicious use of the 
bath will have produced a marked impression on the accom- 
panying fever by the morning of the second day, though some- 
times not before the third. Now give Quinia, gr. iv ; Hydras- 
tin, gr. ij ; every three hours until two or three doses are 
taken. At the same time I find it useful to give a diapho- 
retic, which in this case would be, #, Carbonate of Ammonia, 
3j ; Essl. Tincture of Dioscorea, Essl. Tincture of Asclepias, aa, 



304 The Eclectic Practice of Medicine. 

3ss; Chloroform, 3j; Glycerin, Simple Syrup, aa, 3j; M.; of 
this a teaspoonful may be given every two hours, causing gen- 
tle secretion from the skin and kidneys, and at the same time 
aiding in relieving the pain. 

I am well satisfied that Opium, as above recommended, 
instead of doing harm, as some suppose, has a very marked 
action in allaying the inflammation, though I should not be 
willing to give it as recommended, without first evacuating 
the bowels and quieting the fever. In some cases the first 
medicine given sets up nausea and retching, the stomach being 
so irritable that remedies can not be retained. In such case I 
should give an emetic of Ipecacuanha, and in addition to the 
emesis would generally find that it had evacuated the bowels. 

The injections and local applications heretofore named 
should be employed, as very much depends upon their action. 
If in the later stages there is general tenderness of the bowels 
with tympanitis, equal parts of Turpentine, Tincture of Xan- 
thoxylum and Olive Oil applied to the entire abdomen with a 
cotton cloth is very efficient. As additional injections, when 
the discharges have assumed that peculiar cadaverous charac- 
ter in the typhoid stage of the disease, we may use the solu- 
tion of Chlorinated Soda, from f3ss to f3j to the Oj of 
Water, or the Sulphate of Zinc, 3j to the Oj of water, the injec- 
tion being used in large quantity. 

In the typhoid form of the disease I see no cause to change 
the treatment above named. The addition of Chlorate of 
Potassa to the diaphoretic of Asclepias, or the use of a weak 
solution as a drink is important, as is the free use of stimu- 
lants. Farther than this the disease should be treated as 
recommended for typhoid fever. 

It may be well here to speak of other means that have been 
employed in the severe stages of dysentery. The vegetable 
astringents are used with advantage, in some cases where there 
is more or less diarrhoea following the action of a cathartic, 
and sometimes in the later stages of the disease. The Gera- 
niin, Tannic Acid, Catechu, Kino, Statice, etc., have been used 
in these cases. The Epilobium,in infusion, is sometimes suffi- 
cient of itself to cure dysentery, and is an excellent adjunct 
to the treatment heretofore named. Bismuth, as in the follow- 
ing formula: #, Sub-nitrate of Bismuth, 3j ; Aqua Mentha 
Vir., Siij ; M. ; shake well and give in teaspoonful doses every 
hour or two, is an excellent remedy for sporadic dysentery in 



Chronic Dysentery. 305 

children, and may occasionally be nsed with advantage in 
other forms. The treatment with Ipecacuanha, giving it in 
doses as large as the stomach will tolerate until it opens the 
bowels, and the dysenteric symptoms cease, has been attended 
with good results in many cases. In the later stages of the 
disease, the administration of an infusion of White-oak bark 
in doses of a tablespoonful every hour, with an injection of the 
same, is useful in some cases. Chloride of Silver in doses of 
two or three grains four or five times a day, has been highly 
recommended in the later stages of dysentery, and is decidedly 
preferable to the Nitrate. When the discharges are offensive 
and resemble the washings of meat, injections of Creosote, 3j 
to Starch water, 3xij, is recommended. Ergot, with Tincture 
of Iron was given by Mr. Gervis, with good results. In obsti- 
nate cases these means may be tried in conjunction with the 
treatment before named, but I would not advise reliance upon 
any single agency. 



CHRONIC DYSENTERY. 

Chronic inflammation of the large intestine may result from 
an acute attack, or be excited by diarrhoea, by acrid material 
within the intestinal tube, or from long-continued exposure to 
malarial influence in a hot climate. Like all other chronic 
inflammations there is but little tendency to spontaneous cure, 
and the constitutional disturbance usually increases in propor- 
tion to its duration. Occasionally we find cases in which it has 
continued for years, usually as a gleety discharge from the 
rectum, or lower part of the colon, and produces much less 
constitutional disturbance than we should suppose. Quite 
frequently we find it associated with disease of the liver or 
spleen, and a marked impairment of the blood-making 
organs. 

Symptoms. — The prominent symptom of the affection, is, 
more or less frequent discharges from the bowels, attended 
with more or less pain and tenesmus. The discharges vary 
greatly in character, sometimes a whitish-gray, or yellowish 
mucus, occasionally mixed with blood, but more frequently 
with feculent matter. In some cases j*11 the discharges are 
feculent, but of small size, and at the last part the mucus is 
discharged with tenesmus. In severe cases, the discharges 
20 



306 The Eclectic Practice of Medicine. 

are reddish, pultaceous, with more or less pus, and very 
offensive. The small intestine may he either irritable, or 
torpid; in the first case the fseces are discharged in a fluid 
form; in the second, usually in hard masses, sometimes 
scybalous. In some rare cases we find more or less fluid 
feculent material with every discharge, and suppose from 
this that the small intestines are acting, but the administra- 
tion of a cathartic, will bring away large masses of scybala. 

The condition of the general health varies greatly, usually 
we find a dry, harsh skin, imperfect action of the kidneys, 
irregular appetite, more or less pain in the head, and in 
various parts of the body, with great loss of flesh and 
strength. In some cases these symptoms are very marked, 
the patient being confined to his bed a considerable part of 
the time. 

Where the disease was contracted in a hot climate, the skin 
is frequently sallow and yellow, dry like parchment, or relaxed 
and flabby. In severe cases the disease is complicated with 
an intermittent fever, recurring every day, every other day, or 
at intervals of a week; all the dysenteric symptoms being 
aggravated at these times. The disease continuing, termin- 
ates fatally by exhaustion, or by ulceration and perforation, or 
more frequently by inducing an asthenic condition termina- 
ting in disease of the lungs, liver or brain. 

Diagnosis. — Chronic dysentery is one of the most easily 
recognized of diseases, though the condition of the bowels 
and the complications are hard to determine. 

Prognosis. — "Where of not very long standing, the general 
health being pretty good, there is not much difficulty in its 
removal; but if of long duration, the general health being 
severely affected, and evidence of considerable structural 
change, the prognosis is uncertain, 

Post-Mortem Examination. — As in the acute disease, we 
find the bowel more or less discolored externally, with thick- 
ening in some places and thinning in others, appearance of 
stricture as before named, and more or less displacement; dila- 
tation of some parts and stricture of others, is of quite frequent 
occurrence. On opening the bowel, the mucous membrane is 
seen variously discolored, dusky-red or brownish, or ash-gray, 
thickened at some points, and divested of epithelium, and at 
others well defined ulcers, sometimes small and aggregated, at 
others large, the borders sharp cut and well defined, or irregu- 



Chronic Dysentery. 307 

lar and sloughy. The stomach, liver, spleen and small intes- 
tines, are found affected in some cases, as is also other portions 
of the body. 

Treatment. — The cure of chronic dysentery is usually a 
slow process, requiring care, patience and perseverance, Oc- 
casionally we find that one remedy, as the Epilobium, taken 
constantly, and for a long period, will accomplish it, but this 
is not generally the case. Among the measures employed, 
the irritating plaster holds a prominent place; it should be 
applied in the course of the colon, wherever tenderness is 
detected. Frequently its use so as to produce a crop of pus- 
tules, and then ceased until the irritation subsides, answers 
the purpose; in other cases it should be continued to produce 
free suppuration. The general bath is also an important 
feature of the treatment, for if the skin can not be stimulated 
to normal action, there is but little hope of arresting diseased 
action of the colon. We may use the alkaline or Salt-water 
bath, with brisk friction, or in some cases the entire warm 
bath, or sitzbath; or it may be rendered stimulant by the 
addition of Capsicum in cases of deficient circulation ; or, 
tonic and astringent by the use of a decoction of those agents, 
in cases of relaxation and atony. 

Among the general measures none are more important than 
those restoring the function of the kidneys and stomach. The 
saline diuretics are applicable in all cases in which there is 
headache, a foul tongue and disordered digestion, and may be 
continued in small doses for weeks. If there is febrile action, 
as is the case frequently, Quinia with Hydrastin should be 
employed. In other cases a gentle bitter tonic, as of Cornus, 
Collinsonia, Populus, etc., with some preparation of Iron, 
will suffice. Occasionally benefit is derived from the use of 
Cod-liver Oil and the Hypophosphites. 

For the dysentery different means are employed according 
to the condition of the bowels. Sometimes the administra- 
tion of minute doses of Podophyllin with Leptandrin, thor- 
oughly triturated with Loaf Sugar, answers an excellent 
purpose ; to render it tonic and gently stimulant, Hydrastin 
and Myricin may be added, and to alternate, the Trilliin and 
Euonymin may replace the two last. Where there is tendency 
to atony of the small intestines, with torpor of the liver, a 
better combination could not be asked. The White Liquid 
Physic, followed by Quinia and Hydrastin is highly recom- 



308 The Eclectic Practice of Medicine. 

mended by my friend Dr. Milton L. Thomas, and from its 
action in the acute form, I am led to believe that it will be 
found useful. If there is relaxation of the entire intestinal 
tract, the Geranium, with Leptandrin and Dioscorea answers 
well; or, having restored the functions of the other excretory 
organs, we may use the Per-sulphate of Iron, in doses of three 
grains four times a day. It is in this case that we get the 
most decided action from the Epilobium. 

As regards injections, they are sometimes useful. In sub- 
acute cases, those named under the head of acute dysentery 
may be employed. If there is great irritation about the 
rectum, a strong decoction of the inner bark of the Common 
Elder, with an equal quantity of Glycerin is very efficient, 
as is also the use of a suppository of Belladonna, or an injec- 
tion of Sulphate of Zinc with Morphia. Large injections are 
sometimes employed, as of cold or warm water, an astringent 
or tonic infusion ; or of Chloride of Lime or Potassa, Sul- 
phate of Zinc, Creosote, etc. 

In one case the disease seeming to be confined to the sig- 
moid flexure and rectum, a decoction of Alnus, Eumex, and 
Quercus Rubra, to the amount of a pint, was used as an 
injection three times a day, curing the patient in about four 
weeks, the disease having lasted seven years. 

"When the disease is stubborn and attended with tenesmus 
and feeling of irritation in the rectum, it is well to examine it 
with a speculum, to determine if there is not structural lesion 
that keeps up the irritation. In one case, the patient having 
suffered for some three years, and passed through the hands 
of several practitioners, applied to me for treatment; I 
employed all the means that I could think of as likely to be 
beneficial, for four months, but without any permanent advan- 
tage ; and was about to discharge him as incurable, when my 
attention was casually drawn to the condition of the rectum, 
by his complaining of a sharp cutting pain at the edge of the 
anus. On examination I found a fissure about an inch long, 
and a small polypoid excrescence situate just above it. In a 
moment this growth was snipped off' with the scissors, and an 
incision was made through the entire extent of the fissure, 
about a line in depth. All irritation seemed to disappear, and 
in ten days not a vestige of dysentery remained. In another 
case of nearly as long standing, three internal hemorrhoids 
were found, and a herpetic eruption covering the entire mucous 



Intestinal Worms. 309 

membrane. This was removed by the application of a solution 
of Perchloride of Iron, one part, to two of water. 



INTESTINAL WORMS. 

Intestinal worms may be considered an evidence of disease 
of the mucous membrane, rather than as a disease itself, 
as it is only because the germs of these entozoa have found 
a nucleus in the deranged structure of the bowels, that the 
worms are developed. 

It is yet doubtful how some of them originate, but as the 
G-erman naturalists have recently determined the origin of 
the taenia, we may at once give up the idea of spontaneous 
generation, and by still further research, will doubtless find 
that their mode of transmission from one body to another is 
a very simple matter. Thus in the case of the tenia solium, it 
has been traced from the cysticercus of the pig, through all its 
gradations up to the fully formed worm. These cysticerci are 
very tenacious of life, and may get into the intestinal canaj 
by eating raw or partially cooked fresh pork, or even bacon. 

When once introduced, their development goes on until the 
worm is fully formed ; each joint contains a multitude of eggs, 
which being discharged with the intestinal contents, regains it3 
original habitat, the hog, is developed into a cysticercus, which 
in turn by transplantation, will form a taenia. I have not 
space here for a full description of the various stages, and 
would refer those curious upon the subject to the work of 
Kiichenmeister. 

The principal varieties of intestinal worms, are : the ascaris 
lumbricoides, the ascaris or oxyurus vermicularis, the trichoccpha- 
lus dispar, and the tcenia solium and vulgaris. 

The ascaris lumbricoides, or long round worm, is described 
by Dr. Good as having a slightly incurvated head, with a 
transverse contraction beneath it ; mouth triangular ; body 
transparent ; color, light yellow, with a faint line down the 
side; gregarious, vivacious ; from six to fifteen inches long; 
inhabits principally the ileum, but sometimes ascends i nto the 
stomach, and creeps out of the mouth and nostrils ; occasion* 
ally travels to the rectum, and passes away at the anus. 

The ascaris vermicularis, or small thread worm, has its 
habitat in the rectum, though it sometimes gets into the 
intestines, and occasionally in the female, into the vagina. 



310 The Eclectic Practice of Medicine. 

" The head is subulate, nodose, and divided into three 
vesicles, in the middle of which it receives nourishment; 
skin at the sides of the body finely crenate or wrinkled; tail 
finely tapering and terminating in a point ; gregarious, vivi- 
parous : and about half an inch long. " 

The tricocephalus dispar, or long thread worm, is found in 
the intestines both large and small, and in the stomach, and 
specially in sickly children and those who are poorly 
nourished. 

"The body is obese, slightly crenate, beneath smooth, finely 
striated on the fore part; the head obtuse and furnished with 
a slender retractile proboscis ; tail or thinner part twice as 
long as the thicker, terminating in a fine hair-like point ; about 
two inches long and its color light yellow. " 

The taenia solium, or long tape worm, is described by the 
same author, " as having long and narrow articulations, with 
marginous pores, by which it attaches.itself to the intestines; 
one on each joint generally alternate; ovaries arborescent; 
head with a terminal mouth, surrounded with two rows of 
radiate hooks or holders; and a little below on the flattened 
surface, four tuberculate orifices, or suckers, two on each side; 
it is from thirty to forty feet long, and has been found sixty. 
Inhabits the intestines of mankind, generally at the upper 
part, where it feeds on the chyle and juices already animal - 
ized. Is sometimes solitary, but commonly in considerable 
numbers ; and adheres so firmly to the intestines, that it is 
removed with great difficulty. It is said to have the power 
of reproducing that which has been broken off; but this 
assertion wants proof. The animal is oviparous, and dischar- 
ges its numerous eggs from the apertures in the joints." The 
articulations are from four to six lines in length, and nearly 
as much in width, and resemble gourd or melon seeds. 

" The articulations of the broad tape-worm are short and 
broad, with a pore in the center of each joint, and stellate 
ovaries around them; body broader in the middle, and taper- 
ing toward both ends; head resembling the last; inhabits the 
upper part of the intestines, and feeds on the chyle; from three 
to fifteen feet long; usually in families of three or four." 

Symptoms. — "With many if not all forms of worms, it is 
necessary that the bowels be in a condition to furnish a com- 
fortable habitation. This condition is essentially one of want 
of tone, with, in many, increased secretion of intestinal mucus. 



Intestinal "Worms. 311 

We observe in many cases that the child or person is poorly 
nourished, the muscles are soft and flabby, there is a loaded 
tongue, bad breath, and derangement of the secretions. We 
are not inclined to believe that this is the result of worms, but 
simply coincident with them, and in some cases the patient has 
what is termed worm fever, usually of an intermittent or remit- 
tent character, the paroxysms occurring in the afternoon and 
evening, at which time we find the skin hot and dry, the pulse 
frequent, the head hot, and marked irritability and restless- 
ness, and occasionally convulsions. Or the fever may be more 
obscure, the child is fretful and nervous, sleeps poorly, its 
breath is foetid, tongue coated, bowels irregular, abdomen 
tumid, is frequently picking its nose, the upper lip swells, a 
white line appears around its mouth, and it seems to be out 
of order generally. These are the symptoms of the first 
named varieties, though not nearly so well marked in the 
case of the ascaris vermieularis. Though seeming to be very 
plain, yet all these symptoms may be present, and no worms ; 
or worms present, and but few of these symptoms. The only 
certain evidence of the existence of worms is their presence 
in the faeces, and even then we can not be certain but that all 
have passed. The ascaris vermieularis makes itself known by 
an intolerable itching and crawling sensation about the anus. 
At first it generally comes on after the little patient gets warm 
in bed, the irritation being so great that sleep is impossible; at 
last, they are more or less troublesome all the time. The irrita- 
tion is occasionally so great as to impair the health, and occa- 
sionally gives rise to convulsions. 

As regards the symptoms of tape-worm, they are very 
deceptive. In one hundred cases recorded by Seeger, in 
sixty-eight instances nervous affections, or general or partial 
convulsions accrued — epilepsy, hysteria, abdominal spasms, 
convulsive cough, dyspnoea, melancholy and hypochondri- 
asis; in forty-two, various pains in the abdomen; in thirty- 
three, disordered digestion and irregular states of the evac- 
uations; in thirty-one, irregular appetite and voracity; in 
nineteen, habitual or periodical hemicranias; in seventeen, 
sudden colic; in sixteen, sensations of undulatory movements 
in the abdomen up to the chest; in fifteen, vertigo, delusions 
of the senses, and defects of speech; and in eleven, shifting 
pains in various parts. The only definite evidence of the pres- 
ence of tape-worm is the passage of portions of it with the 



312 The Eclectic Practice of Medicine. 

faeces, and as this usually occurs with this worm, the non- 
appearance of the joints in the evacuations during a consid- 
erable time, may usually be considered as good evidence that 
the worms do not exist in the intestinal canal. 

Treatment. — The treatment of the ascaris lumbricoides and 
tricocephalus will be very similar, the object being to remove 
the worms, and break up the predisposition to them by remov- 
ing the condition on which they depend. Yery many vermi- 
fuge remedies have been recommended and used with success, 
so that the trouble will be, not that we have no remedies, but 
that we have too many. The old-fashioned remedy, "Pink 
and Senna" in infusion, seemed to be about as certain as any 
other agent, and I am satisfied, that if it was as disgusting to 
the worm, as it is to the child, it would readily leave its nest 
in the bowels, rather than take the dose. Still it is not more 
nauseous than the Oil of Wormseed, which is an ingredient 
of all the principal vermifuges — as, #, Oleum Chenopodii, 3x; 
Oleum Terebinthina?, gij; Oleum Ricini, 3iij; Aqua Calcis, 
3x; Syrupus Limonis, 3yj; M.; the dose being two teaspoons- 
ful three or four times a day. Xiichenmeister recommends 
the Santonine, and the Santonate of Soda, for the ascaris lum- 
bricoides; he considers it to be best administered in Oil, in 
order to bring it into solution as readily as possible, and thus 
combine it with Castor Oil, or sprinkle it on bread and butter, 
and follow it with Jalap and Senna. Troublesome effects 
sometimes follow the administration of this remedy, as severe 
irritation of the nervous system, convulsions, tenesmus, bloody 
stools, and the minor disturbances, green or bluish vision, and 
discoloration of the urine. The Santonate of Soda he gave 
in doses of from two to six grains on a Friday night, and the 
same dose on Saturday and Sunday mornings fasting; half an 
hour after this last powder, confection of Senna and Jalap is 
taken in sufficient doses to produce several fluid evacuations, 
the worms passing alive, and sometimes wandering forth with- 
out any operation, the intestines having become unpleasant 
for them. 

A judicious tonic course of medicine, the bowels being kept 
regular, and the other secretions free, with an avoidance of all 
grease or indigestible food, the daily use of the bath, and exer- 
cise in the open air, are the only means by which we can break 
up the tendency to the formation of worms. 

Many remedies have been recommended for the ascaris ver- 



Intestinal Worms. 313 

micularis, but in my opinion all vermifuge medicines should 
be discarded. If the patient's bowels are irregular, proper 
means should be taken to overcome the difficulty, and if neces- 
sary a tonic and bracing treatment adopted. For the worms I 
have always directed an injection of Salt and cold water, in 
the proportion of a teaspoonful, to half a teacupful and so 
far with invariable success. 

For the removal of taenia we may use Turpentine, as the for- 
mula of Kiichenmeister, #, Oil of Turpentine, Castor Oil, 
Honey, aa, 3 j ; to be beat up with the yolks of three eggs, and 
taken at bed-time in divided doses, but within an hour. In some 
cases, he remarks, it is best to give Turpentine in doses of 3\j ; 
at once in the morning, fasting, and if it does not operate, fol- 
low with Castor Oil. It is a very effectual medicine, but 
extremely nauseous, and sometimes irritating to the bowels 
and urinary organs. The Pomegranate bark (Punica grana- 
tum) has been used for the removal of the worm : eight ounces 
of fresh bark being boiled with three pints of water to two 
pints, and taken in divided doses at short intervals until the 
worm is expelled. The objection to this treatment is, that it 
frequently produces violent vomiting, colic and purging, a suf- 
ficient amount of the remedy not being retained to accomplish 
the object. The Male Fern has proven a very successful 
remedy ; previous to its administration the bowels should be 
well moved with the Podophyllin Pill, or Compound Powder 
of Jalap and Senna, and from 3ss to 3jss of the ^Etherial Oil 
administered in mucilage or milk, in the evening, fasting. If 
all the worm does not pass, which is known by finding the 
head, the remedy may be repeated in two or three days, in the 
same manner, and continued until it has all passed. The 
pumpkin seed treatment is highly praised by some : two ounces 
of the seed should be deprived of their capsules, beat into a 
pulp, with sugar and water, and taken upon an [empty 
stomach: in two hours a dose of Castor Oil. The remedy 
should be repeated every other day until the entire worm is 
expelled. The Brayera Anthelmintica or Kosso, was highly 
lauded at one time, though at present it has had to give way 
to the Male Fern : 3ss of the flowers are infused in Oss of 
"Water, and taken in the course of one hour on an empty 
stomach ; it should be followed in two hours with Castor Oil, 
and repeated every two or three days until the entire worm 
passes. 



314 The Eclectic Practice of Medicine. 

STRICTURE OF THE RECTUM. 

Stricture of the rectum, may be either structural or spas- 
modic, most generally a union of the two, as we have no rea- 
son to believe that spasmodic action could take place to such 
an extent as to obstruct the bowel, at least for any considerable 
time. Stricture may result from chronic inflammation, from 
haemorrhoids, from fistula, from cancerous diseases, and in some 
cases without apparent cause. It consists essentially in thick- 
ening of the intestine by interstitial deposit or effusion of 
fibrous material, and the contraction, as is frequently the case 
with this material. It may occur at any portion of the rec- 
tum, from the verge of the anus to the promontory of the 
sacrum, and rarely as stricture of the colon. 

Symptoms. — The symptoms of stricture of the rectum make 
their appearance slowly, usually as difficulty in defecation. If 
the bowel become costive, and the faeces hard, the difficulty is 
very marked, but when semi-fluid it is not noticed ; it is also 
found to be worse from any cause that would excite irritation 
and spasmodic action. When further advanced, the passage 
of faeces is more difficult, and they are ribbon-like in form, 
and sometimes streaked with mucus, pus, or blood. Occa- 
sionally it seems as if the patient could not have an evacua- 
tion at all, there is extreme tenesmus, with colicky pains in 
the abdomen, a feeling of prostration and weakness in the 
lower portion of the body. Continuing, it finally causes maras- 
mus, and severe cachectic disease setting in, terminates the 
life of the patient. 

In cancerous disease of the rectum, there is more or less 
sharp lancinating pain, sometimes seeming to be confined to 
the anus, at others extending to the hip, or down the thigh. 
Passing to the stage of ulceration, there is more or less dis- 
charge of sanies or imperfectly formed pus, and in some cases 
serious hemorrhage. 

Diagnosis. — Stricture of the rectum is diagnosed by the 
symptoms above named, and especially by the ribbon-like 
appearance of the faeces. On examination an obstruction is 
determined in some portion of the rectum, the canal being of 
variable size; if covered by malignant disease, it will have that 
hard nodose feel characteristic of these affections. 

Prognosis. — Usually the prognosis is unfavorable, for even 
though the stricture is temporarily removed, it is very certain 
to again recur ; still some cases may be permanently cured. 



Fissure of the Kectum. 315 

Treatment. — In the treatment of this affection, it is very 
essential that the bowels be kept in a soluble condition, and 
all causes of irritation avoided. An easily digested diet, and 
one that leaves but little debris, should be recommended, which 
with the use of brown bread, and the taking of a glass of cold 
water before breakfast, will maintain the bowels in the best 
possible condition. If a laxative is necessary, Sulphur, Podo- 
phyllin, and Hyosycamus, as, #, Podophyllin, gr. v; Sulphur, 
3ij ; Extract of Hyoscyamus, 3j ; "White Sugar, q. s., to make a 
powder, and divide in twenty parts, of which one may be 
taken morning and night. It is sometimes useful to add a 
bitter tonic, as the Hydrastin. 

To relieve the irritation of the rectum, and consequent spas- 
modic action, a suppository of Belladonna, with butter of 
Cacao, will be found efficient. If there is ulceration, an injec- 
tion of a decoction of Hydrastis, Cornus and Rumex, may be 
employed. For the permanent cure it is necessary that the 
stricture should be dilated with graduated bougies — for which 
see Surgery. 



FISSURE OF THE RECTUM. 

This is an exceedingly troublesome affection, and exerts a 
very injurious influence on the general health, causing in some 
cases derangement of the digestive organs, irregularity of the 
bowels, and great suffering and prostration. The symptoms 
are : a sensation of burning in the rectum, with sharp lancin- 
ating pains, and frequent feeling of tenesmus. There may be 
sometimes a small portion of mucus or blood detected in the 
faeces. Occasionally it gives rise to irritation of the urinary 
and genital organs, which proves intractable, until the fissure 
is removed. A very severe case of uterine disease, in my 
practice, with irregularity of the menses, and profuse leucor- 
rhoea, which resisted all treatment, was readily cured by deter- 
mining the existence of fissure of the anus, and removing it; 
this may be taken as an instance of the effects resulting from 
fissure. 

Treatment. — The treatment, though surgical, is very sim- 
ple, and remarkably successful, which can not be said of the 
old plan of cauterization with Nitrate of Silver, Nitric Acid, 
Chloride of Zinc, etc. The part having been exposed with 
the anal speculum, an incision is made with a bistoury, or seal- 



316 The Eclectic Practice of Medicine. 

pel, the entire length of the fissure, and about a line in depth; 
if the edges are hardened and irregular, they may also be 
trimmed. Nothing further is necessary, the cure being speedy 
and without suffering, and the patient relieved, in a few days, 
of a train of unpleasant symptoms which have afflicted him 
for months. 



ILEMORKHOIDES. 

Hemorrhoides or piles occur at all ages, but are most fre- 
quent after middle life. They occur usually in persons of a 
plethoric habit, and with the venous system prominently devel- 
oped, and especially in those who have unduly stimulated the 
intestinal tract. Persons who have for years led an active 
life, but have become sedentary, are especially liable to them, 
as are also those of sedentary habits, and those whose work is 
heavy and straining. Frequently, however, we find all pre- 
conceived ideas of the cause of the disease at fault, as it occurs 
in the most opposite conditions. 

Constibation is a frequent exciting cause of hemorrhoides, 
and diarrhoea an occasional one. Torpor of the liver, and 
consequent congestion of the portal veins is an important 
element in some varieties. 

Hemorrhoides are divided into external and internal: the 
external being without the sphincter ani, and covered by the 
skin, or partly with skin, and partly with mucous membrane ; 
the internal being within the sphincter, and covered with 
mucous membrane. An external hemorrhoid consists of an 
extravasation of blood into the cellular tissue from a ruptured 
hemorrhoidal vein. The blood coagulates, and the fibrous tis- 
sue surrounding it becomes condensed, so as to form a hard 
nodulated mass. Or, in other cases, the tumor is formed by 
the dilatation of a hemorrhoidal vein, the blood coagulating 
in it, and communication with the vein being entirely or par- 
tially shut off. On the contrary, an internal hemorrhoid con- 
sists of a congeries of arteries and veins, in a varicose condi- 
tion, forming as it were an aneurism by anastomosis, or an 
erectile tumor. The tissues entering into the formation of 
the hemorrhoid are all hypertrophied, and the arteries and 
veins enlarged. It will thus be seen that there is the most 
marked difference between the two kinds, the external being 
non-vascular, and having but an indirect connection with the 



ILemorrhoides. 317 

abdominal circulation ; and the internal being very vascular, 
or closely associated with the condition of the abdominal viscera. 
On thus studying the character of these hsemorrhoides, we can 
readily see why the treatment for one should fail in the other. 

Symptoms. — The symptoms of external hsemorrhoides, is a 
sense of fullness and pressure near the anus, with, in some 
cases more or less of a sharp lancinating, or dull, heavy, aching 
pain. The internal hsemorrhoides give rise to various symp- 
toms, according to their size and position. Usually there is a 
feeling of warmth in the rectum, increased when the bowels are 
moved, and amounting to quite severe pain if the tumors are 
large. When of considerable size they pass down during each 
operation, and more or less blood is discharged at this time, 
giving them the name " bleeding piles.'' Sometimes this hem- 
orrhage proves such a drain upon the system, as to render the 
patient weak and anaemic. At certain times the tumors be- 
come congested, and having once passed down, can not be 
returned, but form a large red, nodulated mass, protruding 
through the anus, and giving rise to uneasiness, pain, and fre- 
quent constitutional disturbance. 

Diagnosis. — The diagnosis of hsemorrhoides is easily made 
by examination ; the presence of enlargement near or within 
the anus being readily detected. "We determine external hsem- 
orrhoides, by their being without the sphincter, and partly 
covered by skin, and hard and nodulated : the internal by their 
florid color, covering of mucous membrane, and being within 
the sphincter, which is their natural position. 

Prognosis. — With proper treatment, almost all forms of hsem- 
orrhoides may be radically cured. 

Treatment. — In the case of external hsemorrhoides, we may 
sometimes succeed in removing them by the use of astringents, 
as a saturated solution of Tannic Acid, or what is better, a solu- 
ution of Persulphate of Iron ; or sometimes the local applica- 
tion of cold, as ice, or ice water. A much better plan, and one 
that is without danger, and certain in its results, is to make an 
incision into the tumor, and turn out its contents. The patient 
should be kept quiet, for two or three days, and a cold coni- 
#press applied, the part usually healing kindly. Studying the 
anatomy of this form of hgemorrhoides, it will be readily seen 
why this is the best treatment, and one applicable in all cases. 
If much hemorrhage should occur, it may be controlled by 
pressure, or an injection of a solution of Perchloride of Iron 



318 The Eclectic Practice of Medicine. 

into the opening. Under no circumstances must this treat- 
ment be used in cases of internal piles, as they being extremely 
vascular, the patient's life would be endangered from haem- 
orrhage. 

It will be recollected that the hemorrhoidal veins entering 
into the formation of internal hsemorrhoides are the most de- 
pendent parts of the portal system, this is the reason why the 
tumors should be so intimately associated with derangement of 
the intestinal canal. As as a general rule, it may be stated, that, 
internal hsemorrhoides are almost invariably caused by derange- 
ment of those organs, and that this is a continuously acting 
cause, no matter how long the disease has lasted. Hence the 
importance of means for removing congestion of the intestinal 
circulation, stimulating the liver to normal action, and over- 
coming constipation. 

Many cases of hremorrhoides may be cured by appropriate 
internal treatment. Thus, in cases of sluggish action of the 
bowels and liver, which in a large majority of cases is an 
attendant, I direct Sulphur Subl., 3ij ; Podophyllin, gr. v ; 
Extract of Leptandra, gr. xx ; Phosphate of Soda, gss ; mix and 
divide into twenty powders, of which one may be taken 
morning and night ; or it may be made into a lozenge^by 
the addition of Gum Arabic and Simple Syrup ; or united 
with Simple Syrup and Honey, may be taken as a conserve. 
Another very good formula, is #, Podophyllin, gr. x ; Extract 
of £Tux Vomica, gr. iij ; Extract of Leptandra, 3j ; Extract of 
Hyoscyamus, 3ss; M., and make forty pills, of which one may 
be taken morning and night, if necessary ; or equal parts of the 
Extracts of Podophyllum, Hydrastis, Leptandra, Apocynin 
and Xanthoxylum, made into pills of usual size, and taken 
morning and night, also answer a good purpose. It will be 
seen that the object of this treatment is to stimulate the 
bowels to action, and get free circulation from the portal 
veins, thus relieving hemorrhoidal congestion. The Conval- 
laria, chewed and swallowed frequently through the day, or 
taken in infusion is sometimes of great assistance. A very 
essential part of the treatment is to restore the skin to its 
normal condition, by the use of appropriate baths and friction. 
If as is usually the case, there is relaxation of the perineal 
structures, use the Salt hip bath, with thorough rubbing of the 
lower portion of the abdomen, pelvis and thighs ; this bath 
should be used cold if possible. Other means that would 



ILemorrhoides. 319 

seem to be indicated, by the condition of the patient, should 
be employed, as it is essential to obtain the best possible 
general health. 

As a local application, nothing is better in a great number 
of cases than an injection of ice-cold water in small quantity, 
or its application if the piles are extruded. In some cases 
when they were down, forming a large mass impossible of 
replacement, I have used powdered ice and salt in a bladder, 
carefully applied, so as not to produce sloughing of the entire 
tumor, with the most marked relief from suffering, and rapid 
diminution of the tumors. In one case the application being 
left to the care of the nurse and patiant, they continued it 
until the entire mass (nearly as large as a goose egg) was 
completely frozen ; it sloughed off by the fourth day, the 
patient recovering without trouble, and not having since had 
the slightest return of the malady; though successful in this 
case, I should not like to repeat the remedy. The vegetable 
astringents are frequently used with advantage in mild cases, 
as #, Tannic Acid, 3ij ; Morphia Sulph., gr. v ; Adeps, 3ij ; M., 
to be applied to the tumors, two or three times daily. Or 
ISTut Galls, 3ij ; Opium, Camphor, Acetate of Lead, aa, 3ss; 
Lard, 3j ; mix thoroughly and anoint the hsemorrhoides two 
or three times a day. Tobacco has been employed in these 
cases, and sometimes with marked advantage ; it may be used 
in various ways ; the common plug, or a cigar may be wet 
and softened and introduced into the rectum ; or a strong 
infusion may be applied to the tumors ; or it may be used in 
the form of an ointment, as #, Tobacco, Stramonium, aa, 3j ; 
freely pulverize and mix thoroughly with Lard, 3ij. 

Among the most efficient means I have used, is the solution 
of Persulphate of Iron, applied to the tumors with a camel's 
hair pencil. In some cases it may be used in full strength, in 
others it will have to be diluted with from one to three parts 
of water. 

In some cases, as when they have resisted the means above 
named, a radical cure may be effected by ligation, the only 
proper operation for this affection. 

The operation is easily performed, the tumors being exposed 
and the extremity seized with toothed forceps, or a tenaculum, 
a waxed thread of saddlers' silk, is applied around the base, 
drawn tightly and tied in a double knot. Sometimes, where 
the base of the hemorrhoid is large, it is necessary to transfix 



320 The Eclectic Practice op Medicine. 

the tumor with a needle carrying a double thread; or, in 
some bad cases, crucially, having four threads, and tying the 
ends tightly, so as to include a portion in each ligature. After 
the application of the ligature, the patient should keep quiet 
until they separate, and if there is much heat and irritation, 
cold water may be used freely. The ligature should never 
be applied to external haemorrhoids, unless the integument is 
freely excised, so that none of it will be included in the loop; 
neither should an internal pile be ever excised, or burned 
with caustics. 



NEURALGIA OF THE RECTUM AND ANUS. 

Neuralgia of the rectum and anus is not of unfrequent 
occurrence, and is especially worthy of notice, as being sym- 
pathetic of other and more serious affections. A person 
suffering pain usually imagines that he could bear it with 
more fortitude if it was located at some other point than the 
one affected, and yet there are some parts in which the pain 
seems more intolerable than others, for instance, of the ear, 
the testicle, or the eye; but of all pain that I have ever wit- 
nessed or experienced this is the hardest to bear. 

We notice it in affections of the bladder and prostate gland 
in the male; in cancerous diseases of the pelvic viscera in both 
male and female; and in diseases of the uterus, ovaries and 
vagina in the female. In other cases we find it existing for a 
longer or shorter time without any apparent cause. It is 
characterized by sharp lancinating or tearing pains in the 
region of the anus, shooting upward to the loins, back, genito- 
urinary organs, and in some cases to the hip joint, and down 
the thigh. In some cases defecation is very painful, as is also 
micturation, the urine being discharged in drops or jets, with 
a scalding sensation. 

Treatment. — In many respects the treatment will be similar 
to that adopted in other cases of neuralgia. Thus, if depen- 
dent upon cold, we would use the spirit vapor bath, with a 
diaphoretic as the Compound Powder of Ipecac and Opium, 
an alkaline diuretic and a mild cathartic. If periodic in its 
character, Sulphate of Quinia, in full doses, should be given 
and repeated as often as seemed necessary. If we can detect 
the lesion giving rise to it, our treatment should be directed 
to this, in the meantime palliating the pain. Among the most 



Peritonitis. 321 

efficient palliatives, is the use of the suppositories of Morphia, 
Belladonna, Stramonium. Tobacco, etc., the use of cold water 
the vapor of Chloroform, Carbonic Acid Gas, both of which 
may be introduced into the rectum by a rubber tube connected 
with the retainer. Counter-irritation is sometimes efficient, 
as is also the external application of Aconite, Belladonna, 
Chloroform, etc. If the pain resists these means, it may 
almost invariably be controlled by the sub-cutaneous injection 
of one-eighth grain of Morphia in solution, repeated as often 
as necessary. Though it is impossible to rationally account 
for the result, experience has proven that these diseases may 
be radically cured by this means, when not amenable to any 
other treatment. 



PERITONITIS. 

The serous membrane lining the cavity of the abdomen, 
and investing the principal viscera, may be the seat of inflam- 
mation, either affecting but a part, or involving the whole 
membrane. As regards the causes of, the affection, we find 
that it may be produced by cold, over-exertion, etc., as in the 
case of other inflammations; but it more frequently arises 
from disease of some organ or part receiving an investment 
from it, or from injuries. The inflammation may be sthenic, 
asthenic or chronic, though we usually see it as an acute 
inflammation, with marked constitutional disturbance. As 
before remarked, it is most generally confined to a small por- 
tion of the membrane, but what is most singular, is, that 
opposite surfaces are involved in the inflammation. Like 
other inflammations, it may terminate in resolution, frequently 
in effusion of plastic lymph, serum, etc., and formation of 
false membrane, or adhesions. 

Symptoms. — The symptoms of acute or sthenic peritonitis 
are well marked ; usually commencing with a marked chill or 
rigor, high febrile action, with quick hard pulse, hot, dry skin, 
furred tongue, headache, and arrest of the secretions is devel- 
oped. The patient complains of sharp lancinating or tearing- 
pain in the part affected, or, if enteric, of the whole abdomen. 
There is exquisite tenderness on pressure, and the patient lies 
on the back and draws the thighs up, to take off the tension 
of the abdominal muscles. As the disease progresses, the 
pain becomes more acute and severe, the patient suffering 
21 






322 The Eclectic Practice oe Medicine. 

intensely. The- pulse is now wiry and very rapid, and the 
tenderness so exquisite that the patient can not even hear the 
weight of the bed clothes. Tympanitis ensues, the abdomen 
being prominent, which also seems to increase the suffering. 
In from two to six days, effusion takes place, with an abate- 
ment of the pain. If the disease still progresses, there is marked 
prostration, with a dark-brownish tongue, sordes on the teeth, 
low muttering, o<r in some cases wild delirium, subsultus, jac- 
titation, picking at the bed-clothes, and death. 

In the sub-acute or asthenic form, it usually results from 
disease of some of the abdominal viscera. The pain is not so 
acute and exquisite as in the preceding case, but is well-defined 
and attended with marked tenderness on pressare. The fever 
is generally remittent in character, sometimes a hectic fever, 
with night sweats. The disturbance of the general health is 
very marked, and there is derangement of almost all the func- 
tions of the body. A considerable portion of the general 
symptoms will undoubtedly depend upon the visceral disease 
causing the peritonitis. 

The chronic form of the disease is of rare occurrence, 
Usually associated with visceral disease, it is very difficult to 
separate the symptoms, and sometimes impossible to deter- 
mine the existence of peritonitis until after death. Tender- 
ness on pressure and evidence of local effusion are the most 
prominent symptoms, though we have frequently good reason 
to suspect the involvement of the serous membrane, from the 
aggravation of the symptoms and their disproportion to the 
original disease. 

Diagnosis. — The diagnosis of acute peritonitis is generally 
easy. The sharp, lancinating character of the pain, exquisite 
tenderness on pressure, hard or wiry pulse, and marked con- 
stitutional disturbance, will serve to distinguish it from all 
other affections. In the sub-acute or chronic form of the 
disease it is more difficult to make a diagnosis ; but the ten- 
derness on pressure, sharp, lancinating, or tearing character 
of the pain, and greater constitutional disturbance than we 
would expect from the visceral disease, is usually sufficient. 

Prognosis. — The prognosis is usually favorable, unless com- 
plicated with other severe disease, or the result of injuries, 
operations, or perforation of the bowel. 

Post-Mortem Examination. — On examination, we find the 
serous membrane thickened, its vessels enlarged, and in acute 



Peritonitis. 323 

cases, a rosy blush, or even marked redness. The free surface 
is roughened, and frequently covered with flakes of coagu- 
lable lymph, in some cases with a semi-purulent material, at 
others showing no evidence of effusion of lymph. If the 
disease has progressed for some time, more or less organiza- 
tion of the effusion will have taken place in the form of false 
membrane, or the formation of adhesions between contiguous 
surfaces. In the sub-acute and chronic form of the affection 
we may find the same adhesions; or the disease being more 
asthenic, there is a shreddy material attached to the free 
surface, or there is more or less of a dirty, semi-purulent 
collection in the peritoneal cavity. 

Treatment. — Acute peritonitis may be treated in two or 
three ways, each being preferable in certain cases. If the 
disease does not affect the visceral portion, I should com- 
mence the treatment with Podophyllin in doses of one grain 
every three hours, combined with three grains of Extract of 
Hyoscyamus, and repeat until the bowels were thoroughly 
evacuated. Then follow with the Compound Powder of 
Ipecac and Opium in doses of from five to ten grains every 
two hours, or Opium in grain doses every three hours until 
the pain is relieved. In some cases it would be advantageous 
to use the spirit vapor bath with this treatment, continuing it 
until free perspiration was induced. If there is nausea and 
inability to retain medicine on the stomach, it is good practice 
to give a thorough emetic, unless there is something to contra- 
indicate it. The Compound Powder of Lobelia answers a 
good purpose, and should be given in infusion, so as to 
produce nausea for one or two hours, and then carried to free 
emesis. A diaphoretic with Opium may then be administered 
as before. 

In some cases I should commence the treatment with the 
special sedatives; #, Tincture of Aconite, Tincture ofVeratrum 
aa, 3ss; Aqua, 3iv; M. ; and give in teaspoonful doses every 
hour. As soon as the pulse begins to come down, the Asclepias 
or other diaphoretic may be used, and Opium or Morphia if 
desirable, to quiet the pain. Occasionally we find it markedly 
periodic, the remissions occurring in the morning, in which 
case, full doses of Quinia should be given during the remis- 
sion. 

As a local application wet <hips, followed by hot fomenta- 
tions of Stramonium, Hops, Lobelia, Boneset, etc., afford 



324 The Eclectic Practice of Medicine. 

marked relief. The cups should be applied over the entire 
seat of the pain, thoroughly drawn and scarified, but not reap- 
plied, as we do not desire the loss of blood. In very severe 
cases, I should follow the cups with a sinapism, and this again 
with the hot applications. In other cases we will find the 
cold applications preferable, relieving the pain when the warm 
fomentations increase it. Again, there are some cases in which 
we have not facilities for the use of any of the measures named, 
or we are afraid to trust them with the attendant; in such 
case we may order a poultice, large enough to cover the entire 
abdomen, to follow the use of the cups. 

Passing beyond the first two or three days, the active meas- 
ures named will have to be relinquished. ]STow we would 
administer a sufficient quantity of the special sedatives to con- 
trol the pulse, and a diaphoretic, as, #, Essl. Tincture of 
Asclepias, 3j ; Carbonate of Ammonia, 3j ; Simple Syrup, 3ij ; 
M. ; and give in teaspoonful doses every three hours. If there 
is tympanitis, we may give with this the Tincture of Xan- 
thoxylum or Turpentine, in doses of about twenty drops. A 
weak solution of Acetate or Citrate of Potassa may be used 
as a drink, the patient taking two or three drachms in the 
course of twenty- four hours. The bowels should be kept in 
a soluble condition by some mild cathartic, as the Compound 
Powder of Jalap and Senna, or the Podophyllin pill, with Hyos- 
cyamus. Very frequently the fever will be found remittent, 
and in such cases Quinia in full doses will be found advantage- 
ous ; or if continued, equal parts of Quinia and Hydrastin may 
be given to the extent of twelve grains of the mixture in the 
twenty-four hours. Stimulants should be employed in sufii- 
cient quantity to keep up the strength of the patient, and 
Opium to gain comfortable nights. 

In the sub-acute and chronic forms of the disease, the treat- 
ment will have to be adapted to each particular case, and will 
depend greatly upon the disease that it is associated with. 
As a general rule, the irritating plaster will be found to be the 
best local application, used as heretofore directed. Careful 
attention to the condition of the skin and kidneys, removing 
irritation of the stomach and bowels, and promoting digestion, 
with remedies appropriate to the removal of the associated 
disease, will be the outlines of treatment. 



Diseases- of the Urinary Apparatus. 325 



CHAPTER V. 

DISEASES OF THE TTKINABY APPARATUS. 

The secretion of urine is one of the most important of the 
functions of the human body, as it is through this channel that 
the greater portion of the nitrogen ized waste of the tissues get 
out of the system. Waste or destruction of tissue is just 
as important in the animal economy as supply or the nutri- 
tion of textures; and we find that the retention of this 
waste is more serious in its results than the want of material 
for nutrition. We will find hereafter that the urine contains 
elements that are poisonous to the human body, and that when 
retained in the blood in sufficient quantity, they exert the same 
influence that would follow the absorption of a narcotic poison. 
Further than this, we have already noticed when considering 
the pathology of fever, that the nitrogenized material which is 
converted into urea and uric acid, may undergo such changes 
by a failure of the kidneys to remove it, as will set up a pro- 
cess of change in living blood, which will finally result in its 
death. 

The urine consists, on an average, of water 1000 parts, 
solids 20 parts, the specific gravity averaging 1020. The pro- 
portion between the fluid and solid portions of the urine varies 
greatly in different persons, and in the same person at different 
periods of the day. Thus, a man may to-day void forty 
ounces of urine of a specific gravity of 1015, and to-morrow 
but twenty ounces of a specific gravity of 1030 ; and though 
the quantity of urine has varied one-half, the amount of solids, 
or the actual secretion, is the same in both cases. The amount 
of urine passed in twenty-four hours having been determined, 
and its average specific gravity ascertained, it is very easy to 
calculate the amount of solids in it. We are not to suppose, 
however, that we have determined the amount of secretion 
as the specific gravity may be changed by the presence of 
foreign elements in it, as sugar, albumen, mucus, and the salts 
of lime, potash and soda, etc. 

The solids of the urine are composed of urea, uric acid, fixed 



326 The Eclectic Practice of Medicine. 

salts, organic matters, and volatile saline combinations. The 
amount excreted during the twenty-four hours, in a healthy 
man, being of urea, 270 grains, uric acid 76 grains, fixed salts 
150 grains, organic matters and volatile saline constituents 
176 grains, or a total of 603.6 grains. 



ACUTE NEPHRITIS. 

Acute inflammation of the kidneys is not of frequent occur- 
rence, as they are situated so deeply, and so well protected, as 
not to suffer from cold or atmospheric changes, or from injury, 
and their circulation is so direct and free, that they are not as 
easily affected by derangements of the general circulation as 
other parts. "When it does occur, it is produced by the usual 
causes giving rise to inflammation, as cold, injuries, local irri- 
tation, the condition of the blood, the sudden arrest of the 
accustomed discharges, too long retention of urine, the exten- 
sion of inflammation from the lower parts of the urinary 
apparatus, etc. Usually but one organ is affected, but in 
some cases both are involved at one time, rendering the dis- 
ease very serious. 

Symptoms. — Inflammation of the kidney usually commences 
with a well-marked rigor, though sometimes but slight chilly 
sensations precede the fever. The febrile action is not high 
at first, but frequently becomes very intense in the course of 
two or three days. With the appearance of the chill, the 
patient complains of a tensive and tearing pain in the loins? 
which is but little increased by pressure. By the second day 
this pain has become a marked feature, and now extends 
down to the hypogastric region, in the course of the ureter, 
to the testes, Causing retraction, and sometimes to the penis. 
This pain is increased by straining at stool and during mictu- 
rition. The urine, at first but little changed, is now small in 
quantity, passed with difficulty, and of a dark-red, or reddish- 
brown color, and frequently tinged with blood. If both 
kidneys are affected, the urine will be very scanty and high 
colored, and passed with difficulty. In a later stage of the 
disease if the calyces and pelvis of the kidney are affected, 
we will observe more or less mucus or muco-pus in the urine. 

The constitutional disturbance becomes marked by the 
second day. There is frequently nausea and vomiting, 



Acute Nephritis. 327 

especially when ai^thing in the slightest degree nauseous 
or irritant is taken upon the stomach ; the bowels are obsti- 
nately constipated, and acted on with difficulty ; the skin dry 
and harsh, the pulse hard and frequent, and at first great irri- 
tation, restlessness and entire inability to sleep ; but if the 
secretion becomes markedly scant, as from disease of both 
kidneys, coma or low muttering delirium sooner or later 
makes its appearance. If but one kidney is involved, we 
will find if the disease progresses, without being controlled 
by treatment, that the fever assumes a typhoid or asthenic 
character by the seventh or tenth day, with dark furred 
tongue, sordes on the teeth, typhomania, etc. If both kidneys 
are affected, the disease will terminate fktally before this, if 
not arrested by medicine. 

Diagnosis. — We diagnose acute nephritis by the deep seated 
pain in the loins, the scanty and high-colored urine, pain pass- 
ing in the course of the ureter to the hypogastric region and 
testicles, and the marked constitutional disturbance. 

Prognosis. — If but one kidney is involved, the prognosis is 
favorable: if both, it is doubtful. 

Post-Mortem Examination. — -Dissection reveals the size of 
the kidney increased, if its entire structure has been involved, 
if but part, the enlargement will be confined to it. The 
inflamed part is of a deep-red color before the formation of 
pus, sometimes brownish and of an ecchymosed appearance. 
If pus is formed, we will find it mottled with gray, the gray- 
ish points not being larger than a pin's head, surrounded by 
the brownish-red tissue. In some cases there are accumula- 
tions of pus, and marked softening of the organ, showing a 
great depression of vitality. 

Treatment. — Prompt treatment is necessary in this case, 
especially if both kidneys are involved in the disease. I 
should administer immediately a full dose of Compound Pow- 
der of Jalap and Senna, and Bi-tartrate of Potassa, in equal 
parts, and if there were great nausea, I would premise with 
an emetic. We use the cathartic as a most efficient means 
of derivation, to lessen the quantity of the circulating fluid* 
and to remedy in part the influence of defective secretion 
of urine. The special sedatives should also be employed as 
heretofore recommended, with the addition of full doses of 
Gelseminum, which seems to have a direct action upon these 
organs. I should use it in doses of from one-fourth to half a 



323 The Eclectic Practice of Medicine. 

teaspoonful every two hours, until its influence upon the sys- 
tem was marked by depression of the eyelids and distorted 
vision. The Essl. Tincture of Asclepias, Diaphoretic Powder, 
or other diaphoretic, may be used in combination with it. 

To aid the action of these remedies we will find it advan- 
tageous to use the hot sitz bath, or, as I have sometimes don'e, 
sit the patient in a tub of hot water, put his feet in a bucket 
of hot Mustard water, with a blanket drawn closely around 
the whole. Previous to this, it is well enough to apply three 
or four cups to the region of the kidneys, well drawn and 
scarified, and especially is this the case if both kidneys are 
involved. The patient being placed in bed after the bath, hot 
fomentations may be assiduously applied until relief is obtained. 
In some rare cases, we might find the wet bandage useful, but 
as a general rule the hot applications are best. 

Until the acuteness of the symptoms has passed off in some 
measure, no diuretic is admissable; but as soon as the bowels 
are freely opened, and the skin is slightly softened, they may 
be used. The remedies should be very mild and unirritating, 
as an infusion of Althge, Yerbascum, Apium, Galium, Polytri- 
chum, etc. As soon as the secretion becomes free, we can 
change these for the tonic diuretics, as the Hydrangea, Agri- 
monia, Collinsonia, Uva Ursi, etc. If there should be hemor- 
rhage from the urinary apparatus, Gallic Acid may be given 
with the greatest confidence. 

As the disease progresses, we obviate to some extent the bad 
effects of retained urine by keeping the bowels open, and the 
secretion from the skin free by the use of warm baths, and 
the internal administration of diaphoretics. Hydrochlorate of 
Ammonia, with Chlorate of Potassa, are favorite remedies 
with me to counteract the influence of urea upon the system. 
Quinia may be used with advantage to control febrile action, 
after the secretion of urine has become tolerably free, but pre- 
vious to this it is rather injurious than otherwise. Opium may 
be used in cases where there is no evidence of uraemia, but 
must be sedulously avoided if there is. Alcoholic stimulants 
are always objectionable. 



CHRONIC NEPHRITIS. 

Chronic inflammation of the kidneys is one of the most 
insidious of diseases, and in this lies its danger. It is caused 



Chronic Nephritis. 329 

by colds, injuries, strains, irritating diuretics administered for 
other diseases, and the extension of inflammation from the 
urinary organs below. It is most frequently confined to one 
kidne} 7 , though it sometimes attacks both. 

Symptoms. — In sub-acute cases the patient has a marked 
sensation of soreness in the region of the kidney, with slight 
soreness on deep pressure; the pain passes in the course of the 
ureter, giving rise to more or less irritation of the bladder, 
retraction of the testicle, and in some cases pain in the hips. 
The urine is scanty, and of a dusky-red or brownish color, and 
causes more or less irritation in its passage. The bowels are 
constipated; the tongue dry, slightly coated with white, and 
fissured; the appetite is poor; the skin dry and harsh; there 
is loss of flesh and strength, with dullness and hebetude dur- 
ing the day, and restlessness at night. Occasionally there is 
an obscure pain in the after part of the day, or in some cases 
it is a marked remittent, there being some fever all the time. 
These symptoms may continue for weeks, the patient becom- 
ing more and more prostrate, and finally, suppuration ensu- 
ing, we have a low form of ataxic fever, which terminates the 
life of the patient in a few days. 

Chronic inflammation of the kidney is not so well marked 
at first. There is usually an unpleasant sensation of weight, 
with occasional soreness in the loins, worse on some days than 
on others, and increased on active exertion. The urine may 
or may not be scanty at first, but becomes so as the disease 
progresses, is usually high colored, and produces more or less 
irritation when passed, usually as a burning sensation along 
the urethra. The testicles are sometimes retracted, at others 
pendulous ; but frequently the patient has recurring pains in 
them or in the penis. In many cases we will find the patient 
complaining of weakness of the back, in the lumbar and 
lower dorsal region ; sometimes pain with tenderness on 
pressure. The bowels are obstinately constipated in a ma- 
jority of cases, and there is occasional nausea and vomiting. 
The mouth is dry and parched, the tongue hard, harsh, 
slightly coated, white and more o# less deeply fissured; if 
there is any one symptom pathognomonic of the disease it 
is this dry and fissured condition of the tongue. 

These symptoms continuing, the patient gradually loses 
flesh and strength, though not confined to the bed. He may 
also, at two or three different times, have exacerbations, the 



330 The Eclectic Practice of Medicine. 

inflammation assuming a sub-acute form, but yielding readily 
to the use of appropriate means. In this way weeks, or even 
months, pass, the patient, though constantly failing, lives in 
hopes of speedy recovery. Finally, acute pain occurs in the 
region of the kidneys, and extends down to the lower portion 
of the urinary apparatus ; the urine is very scant, and contains 
pus and blood; the nausea is constant and vomiting frequent, 
the pulse feeble, wiry and very frequent, and a marked and 
alarming torpor of the nervous system, which passes rapidly 
into deep coma, and the patient dies the second or third day 
of the attack, and sometimes within the first twenty-four 
hours. 

Diagnosis. — We diagnose chronic inflammation of the kid- 
neys by the locality of the pain, its extension to the hypo- 
gastric region, and the testicles; by the weakness of the back, 
the derangement of the urinary secretion and the unpleasant 
sensations on passing water; by the attendant dryness of 
the skin, and obstinate constipation of the bowels ; by the 
loss of flesh 'and strength, and the inefficiency of tonics 
and stimulants to increase it; and lastly by the serious dis- 
turbance of the nervous system, and the peculiar and marked 
appearance of the tongue. 

Prognosis. — If recognized in an early stage the treatment 
is very successful; but if postponed until marked structural 
change takes place, or the vitality of the system is much 
impaired, the prognosis is doubtful. In the final attack but 
very little hope of relief should be held out. 

Post-Mortem Examination. — The changes discovered in 
the kidneys after death are of the most opposite characters. 
Sometimes the organ is atrophied, and seems shrunk and 
shriveled; the structure appears to be greatly lacking in 
blood, and the internal structures indurated, and of a mottled 
appearance. In other cases the organ is markedly increased 
in size, the surface rugose, and the internal structure dark, 
and much softened. Occasionally there is deposit of purulent 
material throughout the kidney, but more frequently we find 
the mucous membrane of the pelvis and calyces thickened 
and covered with a muco-purulent secretion. 

Treatment. — In the treatment of chronic nephritis we must 
be satisfied with slow amendment, as it is not possible for the 
disordered condition of the system to be removed at once. 
The principal point in the treatment is to restore the secretions 



Chronic Nephritis. 331 

of the bowels and skin, and thus relieve the inflamed kidneys, 
and the oppression of the system from retained urea. To 
correct the constipation of the bowels is a work of difficulty. 
I prescribe in some cases an infusion of Leptandra Virginica 
in doses sufficient to produce two evacuations daily ; again, we 
may use, #, Sulphur Subl., 3ij ; Phosphate of Soda, 3ss; Podo- 
phyllin, gr.v; Extract of Hyoscyamus, 3ss; make ten powders, 
or form into an electuary with Honey or Simple Syrup, or into 
lozenges as heretofore directed; or a pill, composed of, #, 
Podophyllin, Extract of Leptandra, Aloes, Hydrastin, Extract 
of Hyoscyamus, aa, 3j ; Extract of Nux Vomica, gr. v; M. ; 
make three grain pills, the dose being one, morning, noon and 
night. These are the proportions I usually employ, but they 
can be varied to suit the indications of the case. 

If there is nausea and vomiting when first called, I com- 
mence the treatment with a thorough emetic; and if the 
necessity seems imminent, evacuate the bowels with the Com- 
pound Powder of Jalap and Senna and Bi-tartrate of Potassa; 
following this, I direct, #, Tincture of Aconite, Tincture of 
Veratrum, aa, gtt. x; Essl. Tincture of Asclepias, 3j; Water, 
5iij; in doses of a teaspoonful every hour until it produces an 
impression on the system, and afterwards every two, three or 
four hours. This should be assisted by an appropriate bath, 
sometimes alkaline, at others stimulant or tonic, and warm or 
cold, as appears best suited to the patient. It should be used 
as often as it seems of benefit, and with the friction of a coarse 
towel or fiesh-brush. 

Among the remedies directed to the kidneys we will find an 
infusion of the Hair-cap Moss about the best, where there is 
much irritation ; or the Apium or Verbascuin may be substi- 
tuted in some cases. We follow these, as the irritation sub- 
sides, with the Agrimonia, Hydrangea, Collinsonia, Uva Ursi, 
Buchu, etc. If there is considerable mucus secretion, which 
continues after the severer symptoms have passed off, we may 
try the Copaiba, Turpentine, or even the Tincture of Cantha- 
rides, in small doses. The Bromide of Potassa, with Santo- 
nine, equal parts, in doses of four grains four or five times a 
day, is useful. The Tincture of Muriate of Iron may also be 
used in doses of from ten to thirty drops three or four times a 
day. As an external application I prefer the irritating plas- 
ter, applied over the diseased part, to all other local applica- 
tions, though if the patient should object to it, we might sub- 



332 The Eclectic Practice of Medicine. 

stitute dry cupping or the application of Croton Oil. The 
pulverized Podophyllin, moistened with warm water, and 
applied once or twice a day for an hour, will sometimes answer 
a good purpose, as will also the Vinegar bandage used, contin- 
uously. 

Tonics and stimulants are not admissible in the early part 
of the treatment, in fact they are injurious until secretion is 
fully established from the kidneys ; then they may be given 
as in other forms of chronic disease. I am satisfied much 
injury has resulted from their improper use in these cases. 
The alkaline diuretics are also excluded at this time, as they 
are very apt to excite such an irritation of the kidneys as will 
still further arrest secretion instead of increasing it. 



GRANULAR DISEASE OF THE KIDJSTEY. 

Brighfs disease, or albuminuria, may occur at any period of 
life, though of more frequent occurrence about middle age. If 
it appears in the young, it is most generally the result of the 
eruptive fevers, particularly scarlatina. It may arise from any 
cause that will induce congestion of the kidney and continue 
it for a considerable time, as the first appearance of albumen 
in the urine may be regarded as an effort of the kidney to 
relieve 'itself of congestion. This diseased function gives 
rise to structural change, which unfits the organs for 
eliminating the normal nitrogenized secretion, and the last 
evidence of its secreting power is found in the separation of 
water and albumen from the blood. The disease may be either 
acute or chronic, the last being by far the most frequent. 

Symptoms of Acute Albuminama. — Occurring almost always 
after the eruptive fevers, or exposure to cold by which the 
surface is suddenly chilled ; it commences generally with a 
well-defined chill, symptomatic fever follows, the pulse being 
hard and frequent, the skin hot, dry and constricted, the 
tongue coated white, the mouth dry, frequently nausea and 
vomiting, bowels constipated, pain in the back, and marked 
restlessness and nervous irritation. "With these symptoms the 
patient complains of a sense of weight and constriction in 
the region of the kidneys, never as is said, extending to or 
causing retraction of the testicles. The pain may be confined 



Granular Disease of the Kidney. 333 

to one side, but one kidney being affected, or it may be equally 
in both sides. 

With the occurrence of these symptoms the urine becomes 
scant, almost suppressed, and highly albuminous, of a reddish 
color, and occasionally bloody. Its specific gravity is almost 
always above that of healthy urine, and it gives an acid 
reaction. "When allowed to rest, it deposits a filamentous 
substance, and when examined with the microscope it will 
present blood-globules, mucus, epithelium, and in some cases, 
complete casts of the urinary tubules. A dirty- white sedi- 
ment is frequently deposited from the urine, not unlike mucus, 
and easily diffused by agitation. The urine is frequently 
passed with difficulty, and sometimes with pain, the calls to 
urinate being frequent and distressing. 

In the course of the second or third day dropsical symp- 
toms make their appearance, most frequently as anasarca of 
the eyelids, face, and at last of the whole body. The skin 
at this time is hot, and does not pit except upon firm pressure. 
If properly treated, in a majority of cases, we find that the 
symptoms are much mitigated in the first three or four days, 
and the disease terminates in recovery by the twelfth to the 
fifteenth day. In other cases, coma comes on by the second, 
third or fourth day, and the disease terminates fatally within 
the first week. Occasionally convulsions appear, and continue 
until the patient is exhausted. In other cases the disease 
seoms to give way slowly until it reaches the chronic stage, 
in which it continues. 

Symptoms op Chronic Albuminuria. — There are no marked 
symptoms in the early stage of the disease to arrest the atten- 
tion of the patient or the physician. It is noticed that the 
patient is gradually losing flesh and strength, and has a 
cachectic appearance. The skin is dry and somewhat harsh, 
and the patient does not perspire on active exertion. as usual. 
The bowels are constipated, or in some cases irregular, diar- 
rhoea alternating with constipation ; the appetite is variable, 
and there are more or less dyspeptic symptoms and headache. 
These symptoms, and loss of strength at last becoming so 
marked, cause the patient to consult a physician, it may be 
months, or sometimes two or three years from the commence- 
ment of the indisposition. On close questioning, we will find 
that the patient has a weakness of the back, probably a sense 
of fullness in the loins, and his attention has been drawn to 



334 The Eclectic Practice of Medicine. 

slight difficulty in passing urine, and some alterations in its 
physical propeities. In all such cases the careful physician 
will institute an examination to determine whether it is 
normal or not, and the character of its constituents. 

"We determine the presence of albumen by the fact that it 
coagulates on the application of heat, and the addition of a 
small quantity of nitric acid, and though other material might 
be thrown down by heat or acid, yet none other by both. If 
we desire to be accurate, a small portion of urine should be 
placed in a small test-tube and heated over a spirit lamp ; but 
if this is not convenient, a common iron spoon may be filled 
half-full, and heated over a common lamp or candle. Dr. 
Bird recommends that the extreme end of the bowl be placed 
over the flame, and in this way the thin layer of urine near 
the end of the spoon soon boils, and the white striae of this 
coagulated albumen gradually diffuses itself through the 
cooler liquid; in this way we can detect a very small quan- 
tity of this substance. The addition of a drop of nitric acid 
to albuminous urine immediately produces a copious coagula- 
tion of albumen. If but a small quantity is present, the 
opacity will disappear on agitation, but may be reproduced 
by the addition of a second drop. Both these tests should be 
employed, for as before remarked we may be deceived by 
one, but can not very easily with the two. 

As the disease progresses the patient becomes very feeble 
and cachectic, and frequently dropsical. The appetite is poor, 
digestion is feeble, the circulation weak, there is great ema- 
ciation, hectic fever appears in the evening, followed by night 
sweats, the patient dying of gradual marasmus, or some other 
affection that is set up owing to the enfeebled condition of the 
system ; or ursemia occurs, and carries the patient off in a very 
short time. Occasionally, in the later stages the urine is 
scanty and but slightly albuminous, so that there is some diffi- 
culty in determining the cause of the constitutional disturbance. 

Diagnosis. — In the acute form of the disease, the symptoms 
usually point more or less directly to the kidneys as the seat 
of the disease, but in the chronic form there may have been 
nothing to direct the patient's attention to it. In all cases of 
marked debility or cachexia, if we wish to determine the 
cause, we make our diagnosis by exclusion ; in this way we 
finally arrive at the truth. But in addition, in this case, we 
would gain the desired end easier, because this is one of the 



Granular Disease of the Kidney. 335 

most important functions, and one that we are always anxious 
about. Having our attention directed to the kidneys as the 
seat of disease, an examination of the urine as heretofore 
named will at once determine the cause of the difficulty with 
great positiveness. 

Prognosis. — In the early stage of Bright's disease the affec- 
tion is amenable to treatment, as are also many cases where 
the disease has progressed for some time; but, at a later 
period, little can be done. "We may determine principally by 
the extent of the impairment of the functions of digestion 
and assimilation. 

Post-Mortem Examination. — In the early stage of Bright's 
disease, the kidneys are found enlarged, their consistence 
greater and of a deeper color than usual. On dividing the 
kidney, the cortical substance is observed to be tumefied, and 
to such an extent as to press upon the malphigian pyramid. 
The malphigian corpuscles are injected, and there is more or 
less albuminous deposit and commencing granulation. Where 
the disease is fully developed the kidney when divided from 
its convex to its concave side, presents a pale yellow surface 
mottled with white as the cortical substance, which is very 
markedly contrasted with the red of the tubular structure. 
The cortical substance is enlarged, and seems to occupy more 
room than in health, especially in its prolongations between 
the pyramids. If the incisions are carefully made, the cortical 
substance seems to consist in considerable part of minute 
granulations, these being the changed malphigian glands 
enlarged by albuminous infiltration. In some rare cases the 
kidneys are reduced in size, and seem to be hard and nodu- 
lated, though in these cases the granulations are not so 
distinct. 

Treatment. — In the acute form of the disease we will adopt 
a treatment in some respects similar to that for acute neph- 
ritis. At the commencement a brisk cathartic of Compound 
Powder of Jalap and Bi- tartrate of Potassa, equal parts, 
ihould be given, and repeated as often as necessary. Cups to 
the loins followed by hot fomentations, are decidedly the best 
means of counter-irritation, and should be used effectually. 
The warm or vapor bath will be found very useful, and may 
be repeated as often as necessary. The bath should be aa 
warm as the patient can bear it, and prolonged for one or two 
hours. When the conveniences for an entire bath can not be 



336 The Eclectic Practice of Medicine. 

had, a most excellent substitute will be found in a large wash- 
tub of hot water, the patient sitting in it, and being closely 
surrounded by blankets. Diaphoretics should be freely 
administered at the same time, and their use continued after 
the bath, the patient being covered warmly in bed, with a 
bottle of hot water to his feet. Diaphoretic infusions seem 
to answer a better purpose than other preparations, and 
almost any agent of this class will be found useful. 

The objects of treatment, as will be seen, are to remove con- 
gestion of the kidney, and stimulate secretion from the skin 
and bowels, and thus relieve the enfeebled organs. The 
measures are active at the commencement, but should be 
changed for such as will maintain a moderate influence as the 
disease progresses. The more acute symptoms having disap- 
peared, and wishing to get rid of dropsical effusion, we may 
use diuretics with moderation; and should any symptom of 
irritation arise, they must be immediately discontinued. I 
like the action of Tannic and Gallic Acids in some of these 
cases. I give the first in doses of twenty grains four or fixe 
tines a day in Glycerin or made into a pill, and the last in 
doses of ten grains every four hours. In cases of dropsy aris- 
ing from acute albuminuria, I have seen marked benefit 
from these remedies when all others had failed. 

In the chronic form of the disease the same attention must 
be paid to the secretions. The warm bath is useful, and must 
be associated with the wearing of flannel and the external use 
of stimulants to prevent exhaustion of the skin. "While it 
is necessary to have the bowels open, we should be extremely 
careful that they are not acted on to such an extent as to pro- 
duce exhaustion, or that an irritation of the intestinal mucous 
membrane is not excited that will prevent proper digestion. 
Counter-irritation is very important, and may be produced 
with the irritating plaster, or by the use of cups to the loins. 
It is recommended that the diet should contain neither fat, 
butter, or any of those non-azotized substances nearly allied 
to it, as starch, sugar, potatoes, etc. 

As regards remedies directed to the kidneys, we may employ 
those which increase their tone and give normal stimulation, 
as, the Collinsonia, Agrimonia, Hydrangea, Eupatorium, 
Purpureum, or if there is dropsy, the Aralia Hispida. In 
some cases the Tincture of Cantharides may be associated 
with these with advantage, the doses being from six to twelve 



Hematuria. 337 

drops, from thirty to sixty drops being taken during the 
twenty-four hours. The Tincture of Muriate of Iron has 
been associated with the Cantharides in some cases, as has 
also the Syrup of Iodide of Iron, and the Iodide of Potassa. 
The dropsy may be treated with hydragogue cathartics, as 
the Compound Powder of Jalap and Bi-tartrate of Potassa, or 
in some cases the Elaterium may be used in place of the Jalap. 
Much care must be used to prevent irritation, and if it appears 
the medicines must be stopped. Digitalis with the Aralia, 
Eupatorium Purpureum, Hair-cap Moss, or Horse-radish, in 
infusion, is sometimes useful as a diuretic. But as before 
remarked, I have obtained better results from the use of Tan- 
nic and Gallic Acids, than from any other remedies. 



HEMATURIA. 

Hemorrhage from the kidneys may result from injuries, 
especially falls or blows upon the loins, from inflammation, and 
from the presence a of calculus in the kidney. It is very gen- 
erally attended with a sense of fullness in the region of these 
organs, and sometimes a dull, heavy aching pain. In almost 
all cases we find a disposition to urinate very frequently, and 
more or less trouble and pain in its passage. Sometimes the 
suffering from this cause is extreme, especially if the hemor- 
rhage is the result of injury. Usually there is also very great 
prostration if an injury should be sufficient to cause bloody 
urine. 

A passive renal hemorrhage sometimes precedes Bright's dis- 
ease, and according to Dr. Crooke, is marked by the following 
symptoms: "A pallid complexion, of a dirty- white or muddy 
color; with dilated pupils; occasional headache and singing 
in the ears; the tongue is large, flabby and furred, the edges 
thereof indented by the teeth; the bowels are open and loose: 
there is much flatulence and nausea, with irregular appetite; 
palpitation is frequent; the surface of the body is cool: the 
skin soft and relaxed, but dry; the pulse full, soft and bound- 
ing, or small and soft, putting on the former condition on 
change of posture; there is gradual but progressive emacia- 
tion; irritability and gloominess of temper, with great disin- 
clination to exertion, either bodily or mental." The local 
symptoms are usually a sense of weight and fullness in the 

99 



338 The Eclectic Practice of Medicine. 

loins, with a dull, obscure pain, sometimes referable to the 
penis, testicle, hip, inside of the thighs or perineum. 

Diagnosis. — In hemorrhage, the result of injury, as well as 
in some cases of acute hemorrhage from other causes, the pre- 
sence of blood will be very distinct, in fact, in some cases, 
very little but blood seems to be passed. According to Dr. 
Bird, "When blood is effused in any considerable quantity in 
the urine, it coagulates into masses like black currant jelly ; 
and when it partly coagulates in the bladder, linear masses of 
clot of nearly the shape of leeches, are passed from the urethra, 
often to the great distress of the patient, by producing tempo- 
rary suppression of the urine. Even after this coagulation, the 
urine retains a port wine color, and the microscope detects an 
abundance of entire blood corpuscles; although in a great pro- 
portion of them the investing membranes have given way, 
and the colored contents become diffused through the urine. 
If too small a quantity of blood has been effused to give a 
decided red color to the urine, it will be frequently found pos- 
sessing merely a dirty, dingy hue; less frequently being of a 
pink color, like the washings of flesh." 

Treatment. — In acute hematuria the patient should main- 
tain the recumbent position, and keep as quiet as possible. 
The cold, wet bandage may be applied around the abdomen, 
the patient being covered warmly with blankets, and a bottle 
of hot water placed at the feet. If there is excitation of the 
pulse, as there generally is in these cases when not the result 
of injury, I should administer Tincture of Veratrum and Digi- 
talis, until its influence was marked. Associated with this, 
Gallic Acid should be ^iven in doses of five grains everv hour 
or two, or if the hemorrhage is severe, every fifteen or thirty 
minutes. No agent has had such a marked effect in my 
practice. 

In hemorrhage from injury it is essential many times that 
vigorous means be used to overcome prostration and determine 
the blood to the surface and extremities. For this purpose 
we may substitute stimulant applications for the wet bandage, 
and apply cloths wrung out of hot Mustard water to the lower 
extremities. Brandy may be given in moderate quantities if 
it seems necessary, and small doses of Carbonate of Ammonia. 
To arrest the hemorrhage, give Gallic Acid in doses of five 
grains frequently repeated, associated with from three to ten 
drops of Oil of Erigeron. 



Diabetes, 339 

In passive hemorrhage I should direct the free use of dry 
cups over the entire lumbar region, followed by a poultice of 
a decoction of equal parts of Podophyllum and Cornus, with 
Wheat-bran.. The warm bath may be used once or twice 
daily with marked advantage, but further than this the patient 
should be kept quiet in bed. If there is nausea with irrita- 
tion of the stomach, the infusion of Peach-tree bark, before 
mentioned, will be found an admirable remedy; and in addi- 
tion we may use Creosote in doses of one drop, made into a 
pill with two grains of Rhubarb, and half a grain of Hydras- 
tin. Gallic Acid is one of our most efficient remedies in 
arresting hemorrhage, given in doses of five grains every two, 
three or four hours. Oil of Erigeron seems to answer a good 
purpose, but in many cases causes irritation of the stomach; 
Turpentine has been used with success in these cases, in doses 
of from ten to thirty drops. When much irritation of the 
urinary passages exists, we may use Santonin in small doses, 
triturated with white Sugar, or if confined principally to the 
bladder and urethra an Opium injection or suppository will be 
of advantage. 



DIABETES. 

By diabetes we understand a condition in which there is an 
excess of urine passed. The forms recognized by most 
writers are, diabetes insipidus and diabetes mellitus ; the first 
being simply excessive in quantity, but without change in its 
constituents, though of low specific gravity; while the last is 
not only excessive in quantity but contains an abnormal 
constituent — grape sugar. The causes of both forms of dia- 
betes are very obscure, as is also the pathclogy of the affection. 
The first form is doubtless induced by any cause that would 
induce long-continued excitation of the organs, resulting in 
an enfeebled and sluggish circulation. The second is no 
doubt partially a disease of digestion, of assimilation, and of 
the liver and lungs. 

Symptoms. — Diabetes insipidus may come on slowly and 
gradually, or its advent may be sudden. The patient's atten- 
tion is directed first to the increased frequency of the calls to 
micturate, and especially by having to get up at night to 
relieve the bladder; then that the urine is passed in large 
quantities at a time, and that it is very clear. At the same 



340 The Eclectic Practice of Medicine. 

time he feels a sense of lassitude and languor, with pain in 
the back, and considerable thirst ; the appetite is somewhat 
impaired, digestion imperfect, the skin soft and doughy, or 
dry and constricted. These symptoms may make their 
appearance so as to be marked in a couple of weeks, or they 
may be months in their development. Continuiug, it may 
result in diabetes mellitus, or by enfeebling the system pre- 
dispose to severe cachectic affection. 

Diabetes mellitus may come on slowly or rapidly. In some 
cases months will have passed before the patient thinks his 
condition so serious as to demand the assistance of a physi- 
cian; but in a majority, from four to eight weeks is sufficient 
for the full development of the affection. It comes on insidi- 
ously, without a pain or an ache; or any symptom that could 
be called disagreeable. The patient notices that he is losing 
flesh and strength every day, and is becoming so feeble that 
it is with difficulty that he is able to attend to his business, 
and at the same time that he eats nearly as much as usual. 
His attention is called to the frequent calls to pass water, and 
especially that he has to rise during the night, and that the 
amount in the vessel in the morning is very large. These 
symptoms continue to increase until the patient becomes very 
feeble and thin in flesh, and is scarcely able to get about, 
being confined to the room the greater portion of the time, 
and still there is no suffering. The thirst is usually a very 
marked symptom, the patient having an almost constant 
desire for, and drinking large quantities of fluids. 

As the disease progresses toward a fatal termination, we 
observe hectic fever in the afternoon, with night-sweats. The 
thirst still continues and is frequently intense; but the appe- 
tite is much impaired and capricious. Sometimes phthisis 
sets in and runs its course rapidly; at others the patient is 
siezed with a colliquative diarrhoea; and in others the kidneys 
fail to remove the necessary amount of urea, and the patient 
dies of uremic coma. 

Bernard has proven conclusively that sugar is a normal 
secretion of the liver, and that by irritating the eighth pair 
of nerves at their origin in the fourth ventricle he could 
markedly increase its quantity. That it does not exist in the 
general circulation in a state of health, though constantly 
secreted, is explained by its rapid decomposition and excretion 
from the lungs. But if secreted in large quantity, and in a 



Diabetes. 341 

condition in. which the lungs do not act with normal power, 
it would then remain in the blood, but being foreign to it 
would be excreted by the kidneys, giving rise to diabetes. 
We may then conclude that diabetes is dependent upon in- 
creased hepatic action, at least so far as the formation of sugar 
is concerned, and deficient pulmonary action. This last is 
borne out by the fact that diabetic patients usually die 
phthisical. I have no doubt that there is also some derange- 
ment of the blood, probably dating back to the digestive 
process, as the secretion of the liver, according to Bernard is 
aofc sugar, but a substance similar to starch, and which re- 
quires a peculiar ferment to produce the transformation. 

Diagnosis. — Diabetes is known to exist, b}^ the large quan- 
tity of water passed daily, and by the symptoms of emaciation 
and debility which attend it. To determine whether it is 
diabetes insipidus or mellitus, an examination of the urine 
must be made. The urine will usually be found of high 
specific gravity, 1030 to, sometimes, 1040, though occasionally 
it may not exceed 1020, and may sink to 1010. Barns's test 
is the one most frequently resorted to, to determine the pres- 
ence of sugar: "Place in a test-tube about two drachms of 
the suspected urine, and add nearly half its bulk of liquor 
Potassae. Heat the whole over a spirit lamp, and allow active 
ebullition to continue for a minute or two ; the previously 
pale urine will become of an orange-brown, or even bistre 
tint, according to the proportion of sugar present. The sub- 
sequent addition of an acid generally causes the evolution of 
an odor of boiling molasses. " 'The only source of error in 
this test is, that the solution of Potassa employed may contain 
lead, in which case, uniting with the sulphur of the urine, it 
would give rise to very similar change of color; hence the 
solution should be known to be pure, and kept in green glass 
bottles free from lead. A very simple method of treating 
urine is to put a small portion in a bright iron spoon, and 
evaporate it over a spirit lamp ; if sugar is present, it will 
give the iron a peculiar reddish-brown hue, and sometimes 
the smell of carmel will be very apparent. If allowed to stand 
in a warm place a scum forms upon the surface, looking as if 
flour had been dusted upon it; if this is examined with a 
microscope it will be found to consist of a jointed confervoid 
growths and smaller cells ; this is the torula cerevisias. 
Another fact worthy of notice is, that saccharine urine never 



3-12 The Eclectic Practice of Medicine. 

possesses the putrid smell of the decomposing urine of healthy 
no matter how long it may stand ; this is accounted for on 
the supposition that alcohol is generated by the fermentation 
of the saccharine matter. 

Prognosis. — The prognosis in diabetes insipidus is very 
favorable, but in diabetes mellitns it should be very guarded. 
There is no doubt in my mind that a majority of patients will 
die of the disease ; some will recover perfectly. 

Post-Mortem Examination. — In many cases, no pathological 
lesions exist that would give the slight assistance in forming 
an opinion of the pathology of the disease; in fact, no lesion 
is found constantly,, as in some other forms of disease. The 
kidneys have been found smaller than usual, and increased in 
size, of greater or less density, of darker color and blanched, 
but in a majority of cases very nearly natural, with a slightly 
increased turgescence and enlargement of the blood vessels, 
The liver has more frequently been found diseased, if we are 
to believe writers on this subject, but some have been unable 
to determine any change. The lungs usually suffer to some 
extent in the latter stages of the disease, but the lesions are 
those of phthisis or a low form of inflammation, and have no 
relation to the diabetes further than they are induced by the 
debility produced by that disease. 

Treatment. — The treatment of diabetes is not as successful 
as might be desired, and is almost entirely empirical. It is 
claimed by most writers that a diet almost exclusively animal, 
so as to avoid to as great an extent as possible the material foy 
the formation of sugar, is indispensable. While satisfied that 
this is good treatment, I doubt very much the correctness of 
the reasoning. I am of the opinion that the stronger the diet 
the better the patient gets along, and am thus in the habit o-f 
giving the patient freely of ale, poster or beer, and a diet of 
eggs, beef, mutton-chop or game, with milk and bread and 
butter. If the appetite is impaired, and evidence of want of 
tone of the alimentary canal. I use a tonic combination as 
follows : $r, Quinia Sulphas, gr. xxx : Hydrastin, gr. xx ; 
Extract of Kux Vomica, gr. ij ; Extract of Xanthoxylum, gr. 
x ; Sulphuric Acid, q. s.; M., and make twenty pills, of which 
the patient may take one four times a day. As a continuous 
tonic and stimulant, I like the action of Collinsonia, given in 
the form of tincture, combined with Simple Syrup. The only 



Diabetes. 343 

two cases I ever cured had in addition to these means, one 
drachm of Gallic Acid daily. 

I like the theory of Dr. Inman, and, to some extent, the 
practice ; he was guided by the following considerations : "1. 
The liver naturally produces sugar in a definite quantity. In 
diabetes there is an excess of sugar, and we may fairly infer 
that it comes from the liver. Opium has a decided effect in 
diminishing the bile-producing or secreting function of the 
liver, and it is reasonable to suppose that it will reduce the 
sugar-forming formation. Experience has long told us that 
no single remedy in diabetes has been so efficacious in dimin- 
ishing the quantity, etc., of urine passed, as Opium. Opium, 
therefore, should be an ingredient of the treatment. 2. Again, 
Bernard has shown that the liver makes sugar, no matter 
what is the nature of the food employed. Dr. Budd has shown 
that some patients at least, may be benefited by saccharine 
food. But my patients did not long for sugar ; and they 
did not enjoy their ordinary food ; consequently I neither 
restricted them to non-saccharine or non-amylaceous diet, or 
prescribe unusual quantities of sugar. They were to have 
the ordinary full diet of the hospital, but more in quantity if 
they chose, either of bread, meat or potatoes. 3. Again, it 
seems to be clear, that in diabetes, there was debility implicat- 
ing more or less the whole system : that there was danger of 
death by consumption ; that the digestive powers, notwith- 
standing their apparent energy, must be impaired; at any 
rate that Opium was liable to disorder the stomach, and that 
it could be tolerated in larger quantity, if combined with 
Quinia. The result of these convictions was the following 
prescription for a pill : Opium, 3j ; Quinia, 3ij ; to be taken 
every four hours. Full house diet, with Porter daily. " 

A great many remedies have been recommended in diabetes, 
the more noted of which may be named. The Tincture of 
Cautharides has been pretty extensively employed in this 
country; it should be commenced in doses of ten drops every 
three hours in mucilage, and may be gradually increased up 
to thirty drops. Ammonia has been strongly recommended; 
Dr. Barlow gave the Sesqui-carbonate in doses of live grains 
every three hours; M. Bouchardat, a mixture of Carbonate of 
Ammonia, 77 grains; Bum, 310 grains; Water, 1,550 grains, 
one-third to be taken half an hour before each meal ; Liquor 
Ammonia has been recommended by several ; Dr. Colles gave 



344 The Eclectic Practice of Medicine. 

a mixture of this and Lime-water. The Permanganate cf 
Potassa has been employed, and it is observed with good 
results, as has also the Sub-acetate of Lead. All of the 
astringent diuretics have been used, and each has been lauded 
as a curative; but without any just ground; in fact, I am 
inclined to believe that they are more frequently hurtful than 
otherwise. Remedies that act on the liver, as the Sanguin- 
aria, have been recommended and employed to considerable 
extent, but so far as I can learn, without advantage. 

Dry cupping to the spine, with the use of a salt sponge 
bath and brisk friction, are very important elements of the 
treatment. The patient should wear soft flannel next to the 
skin, and keep the extremities dry and warm. Exercise 
should be taken in the open air to as great an extent as pos- 
sible short of fatigue, and the sleeping room well aired and 
sunned if possible. 

Diabetes insipidus is usually arrested very readily by get- 
ting a free action of the bowels and skin, and checking the 
urinary secretion by the administration of Gallic Acid and 
Opium. Sometimes the astringent diuretics may be used with 
advantage, as the Uva Ursi, Buchu, Chimaphila, etc., or the 
use of Turpentine, Tincture of Cantharides, or Creosote. In 
some cases I have seen most marked effects from a combination 
of, #, Podophyllin, Morphia Sulphas, aa, gr. v; Saccharum 
Album, 3j; M., triturate thoroughly, and divide into twenty 
powders, of which one might be taken every four hours; one 
grain of Hydrastin may be added to each dose, if the patient 
needs a tonic, or if the appetite is poor, or the digestion feeble. 



ISCHURIA. 

Arrested discharge of the urine is rather a symptom than a 
disease, and may occur in various conditions of the system, 
and from various causes. It may be divided into two forms: 
ischuria renalis or arrest of the secretion, and ischuria vesicalis 
or retention of urine. 

Suppression of urine may be caused, as we have already 
seen, by inflammation of the kidneys or from chronic structu- 
ral disease, or from the presence of a calculus in the pelvis of 
the kidney or ureter, or from sudden congestion of the kid- 
ney from cold or shock to the system, or from exhaustion or 
enfeebled nervous action during many acute diseases. It is 



Ischuria. 345 

usually only partial, as the lesion would have to be very severe 
that would cause a total suppression. 

The symptoms of suppression vary greatly according to the 
cause and the condition of the system. If from inflammation, 
we will have had the marked evidences of that disease pre- 
viously, and so in the case of chronic structural disease. If 
from renal calculus there will usually have been previous 
symptoms of diseased kidney, and the arrest will frequently 
be attended with sharp pains in the kidney and back, with 
chills, prostration and febrile action. If from sudden conges- 
tion or shock, there will have been no previous symptoms, or 
may be a sense of weight and oppression in the lumbar region, 
with disposition to void urine, but inability to do so # If dur- 
ing acute disease, the first evidence will be manifestation of 
symptoms of ursemic poisoning. In all these cases, we will 
notice a gradually increasing stupor, with disordered innerva- 
tion. In some cases, there will be partial or complete convul- 
sions, in others pain in the back, and wandering pains through- 
out the body, the patient being uneasy and restless; and in 
others an intense pain or feeling of constriction in the head. 
]STausea and vomiting frequently occur, and the irritability of 
the stomach seems in some cases to be a leading feature of the 
disease. As time passes, we find the coma becoming deeper, 
until at last it is impossible to arouse the patient, the pulse is 
feeble and irregular, the extremities cold, the countenance 
hypocratic. and more or less convulsive movement until death 
ensues. 

Retention of urine may occur from paralysis of the bladder, 
or from irritation of its neck or the urethra, or from the pres- 
sure of adjacent organs, or the presence of a calculus. Reten- 
tion from paralysis is of quite frequent occurrence in typhoid 
and other low forms of fever and inflammation, and is one of 
the features of those diseases that the physician will have to 
be on the constant lookout for. In this case it will be noticed 
that the prostration is much greater, and the symptoms are 
more grave than were anticipated, and frequently there is 
more or less coma. On inquiry, it will be found that the 
urine has not been passed lately, and on examination the 
bladder will be found distended. Sometimes the attention is 
drawn to it when the retention is but partial by the disposition 
the patient manifests to keep his hand upon the lower part of 
the bowels, or clutching at something at that point. The 



346 The Eclectic Practice of Medicine. 

bladder may be paralyzed by too long retention of the urine, 
as in urethritis, or in affections of the adjacent pelvic vis- 
cera, in which micturition is painful. In these cases the 
patient feels an undue distension, sometimes amounting to 
pain, and and, on attempting to pass water, finds that he has 
no control over it. Now the patient's suffering becomes 
intense. He has a constant desire to micturate, and is fre- 
quently attempting it, the effort being attended with pain and 
feeling of great distension, as if the bladder would rupture, 
which sensation is constant. If the result of irritation of the 
neck of the bladder or urethritis, the patient has, in addition 
to the feeling of distension described above, a severe, scalding 
pain, witb more or less sharp, lancinating pains in the peri- 
neum and anus, and sometimes in the small of the back. The 
symptoms of retention from presence of a diseased or mis- 
placed uterus, or from disease or impaction of the rectum, 
or enlarged prostate, are very similar. If the retention is 
produced by a calculus, it comes on during an attempt to mic- 
turate, the flow of urine being suddenly stopped; now the 
patient experiences a constant tenesmus and desire to evacu- 
ate the bladder, with exquisite, tearing, burning and lancina- 
ting pains at the neck; these pass off* in a short time, but 
continually recur until the difficulty is overcome. 

Diagnosis. — It is not difficult to determine that ischuria 
exists, but sometimes troublesome to determine whether it is 
suppression or retention. Suppression of urine is very fre- 
quently attended with unpleasant sensations in the region of 
the kidneys, there is stupor, deranged innervation and coma; 
and if further evidence is wanting, the passage of the catheter 
elicits the fact that there is no urine in the bladder. Reten- 
tion of urine is characterized by a feeling of fullness and 
distension of the bladder, and with tenesmus and desire to 
evacuate it, but inability to do so. Of course, in low forms of 
febrile and inflammatory diseases, the only means of deter- 
mining is by abdominal palpation and the use of the catheter. 

Prognosis. — The prognosis is unfavorable in cases of sup- 
pression of urine, if it is anything like complete, as ursemic 
poisoning progresses rapidly. If there is still some secretion, 
and in proportion to its arrest and the already depressed con- 
dition of the system, the prognosis will be favorable. In 
retention of urine we can nearly always give a favorable prog- 






Ischuria. 347 

nosis, as even when it results from an impermeable stricture, 
a false opening is practicable. 

Treatment. — In inflammation of the kidneys with suppres- 
sion, most active means will have to be employed to relieve 
the kidneys, both being involved. Cups, with scarification to 
the entire lumbar region, followed by the hot bath, or sitting 
the patient in a large tub of hot water with the feet in Mus- 
tard water, and closely covered in with a blanket, should be 
immediately resorted to. The water should be kept as hot as 
the patient can bear it by the frequent addition of hot water, 
and it should be continued for hours, or until the urine com- 
menced to pass. A brisk hydragogue cathartic, as equal parts 
of the Compound Powder of Jalap and Bi-tartrate of Potassa, 
should be administered at once, and repeated if necessary. 
Some warm diaphoretic infusion should be administered freely 
combined with a mucilaginous drink, as the Asclepias with 
Althaa, the Eupatorium with Hair-cap Moss, etc. As soon as 
the bowels are acted on, I should administer a combination of 
equal parts of the Tinctures of Gelseminum and Macrotys, in 
doses of thirty drops every honr, until the full influence of 
the remedies are obtained. If any remedies will lessen the 
inflammation and cause secretion, these will do it. 

In chronic structural disease of the kidneys suppression is 
almost invariably fatal. "We will have had several days' notice, 
in a majority of cases, the urine becoming less and less; and 
during this time the appropriate means will have been used, 
so that when the symptoms of urcemic poisoning occur we 
have no remedies to combat it. In these cases it is important 
to keep up free action of the bowels and skin, and by these 
means life may frequently be prolonged for a considerable 
time. In cases of sudden congestion from shock or cold we 
would employ cups to the loins, the hot, stimulating hip and 
foot bath, the administration of a brisk hydragogue cathartic, 
followed, as soon as their effects had been produced, by a 
stimulant diuretic, as, #, Oleum TerebinthinaB, Spiritus ^Ethe- 
ris Nitrici, Tinctura Juniperi, aa, 3ss; M.; give in closes of a 
teaspoonful every hour or two hours, in an infusion of Hair- 
cap Moss. The same treatment would be applicable in cases 
where we suspected the presence of a calculus, and in addition 
Hyoscyamus might be given to allay pain, as might also the 
Tincture of Verbascum. 

In cases of retention of urine from paralysis, it is better to 



348 The Eclectic Practice of Medicine. 

draw it off first with a catheter, if of long duration ; if not, a 
stimulating enema, as of Turpentine, with warm Water, and 
Castor Oil, aided by a warm Mustard sitz-bath, will be suffi- 
cient. There is only one agent that I would recommend inter- 
nally in these cases before the urine is drawn off, and that is 
Santonin; it may be given in doses of from one to three grains 
every hour until the urine is evacuated. This agent is espe- 
cially applicable in the case of retention of urine during acute 
disease in children, and rarely fails of accomplishing the pur- 
pose. After the urine has been drawn off, the patient should 
be instructed to pass it frequently, and as an aid we might 
administer a stimulant diuretic, as Cubebs, Copaiba, Buchu, 
Tincture of Cantharides, etc. When there is great want of 
power, in chronic cases, the Xux Vomica may be given with 
good results, and in some cases it will be advantageous to use 
electricity. 

In cases of irritation of the neck of the bladder and urethra 
and in sympathetic irritation from disease of adjacent organs, 
we find that an injection of Opium is in many cases sufficient; 
I usually order it as follows: #, Tinet. Opii, Tinct. Gelseminre, 
Tinct. Lobelhe, iia, gtt. xl; Aqua, 3ij; M. ; use as an enema, 
and repeat in half an hour if necessary. Internally, no reme- 
dies will be found more efficient than the Tinctures of Gelsemi- 
num and Macrotys in doses of twenty drops of each every 
hour until relief is obtained. To favor the action of these 
means, we employ the warm sitz bath as heretofore named. 
After the patient is relieved, we would treat the disease caus- 
ing it according to the indications. 



ENURESIS. 

Incontinence of urine should properly be considered after 
diseases of the bladder, but as we have just noticed reten- 
tion, we may notice it here. Though not a very frequent 
affection, it is yet met with sufficiently often, and its symp- 
toms are so disagreeable, as to merit careful study. It is of 
more frequent occurrence during childhood, and may be in 
these cases attributed to atony of the muscular fibers closing 
the neck of the bladder, or to an irritation of the nervous 
fibrillaB distributed to the mucous membrane of the bladder, 
which prevents normal distension of that organ. In the adult 



Enuresis. 849 

it is frequently the result of injury, as in cases occurring after 
labor, or in consequence of long-continued disease of the ure- 
thra or bladder. 

Symptoms. — The symptoms of the affection vary in different 
cases; some bewig able to partially retain the urine, while 
others have no control over it at all. In the worst cases it 
continually dribbles away as it is passed into the bladder, the 
patient being unable to retain it. As the result of this state 
of affairs we find that the person is rendered filthy, and is 
debarred society on account of the disgusting urinary odor 
that he can not get rid of. There is also more or less irrita- 
tion of the genital organs, and of the adjacent integument, 
sometimes very severe, resulting in deep foul-looking ulcers. 
In other cases, it is retained to the amount of a few drachms, 
and then commences to dribble away, unless the patient has 
an opportunity to void it. In other cases, the bladder being 
irritable, it is forcibly expelled, after having accumulated to a 
certain extent, the patient having no power to resist its expul- 
sion. Incontinence of urine at night is a troublesome affec- 
tion among children, and even the physician is frequently 
consulted about it; but unlike the other it usually arises from 
an irritability of the bladder, which assuming control when the 
will is in abeyance or during sleep, causes the discharge. 

Diagnosis. — There is little difficulty in determining the exis- 
tence of enuresis, but care should be used to ascertain definitely 
the cause. In females a careful examination should be made 
to determine that the constant dribbling of urine is not conse- 
quent upon vesico-vaginal fistula. 

Treatment. — When dependent upon atony and relaxation 
of the circular fibers at the neck of the bladder, the best 
results will be obtained from the internal use of Xux Vom- 
ica and Cantharides, with a tonic bracing treatment ; I 
usually direct, 3£, Extract of Is ux Vomica, gr. iv ; Hydras tin, 
3ss; Extract of Macrotys, q. s. ; make thirty pills, of which 
one may be taken three or four times a day. The Tincture 
of Cantharides may be associated with it or used separately in 
doses of from ten to thirty drops three or four times daily .Bel- 
ladonna has been recommended, and is no doubt useful; it is 
usually associated with IN"ux Vomica, the dose being about 
one-fourth to one-eighth of a grain of the alcoholic extract. 
I have employed the stimulant diuretics, as Styrax, Tolu, 
Cubebs, Copaiba, and Turpentine, but without any permanent 



850 The Eclectic Practice of Medicine. 

good effect. Dr. Steinbeck prescribed for incontinence of 
urine after labor, #, Ergot, 3ss; infuse in Water, 3yj ; boil 
for a few minutes, and add of Belladonna leaves, gr. xv ; when 
cool, strain the infusion, and add of Phosphoric Acid (medi- 
cinal strength,) 3ij ; Extract of iSTux Vomica, gr. iv ; Syrup of 
Manna, 3j ; M., and give in doses of a teaspoonful every two 
hours. M. Froriep recommended the use of electricity, a 
metalic stylet being introduced into the bladder through a 
gum catheter, one of the wires is connected with the stylet, 
the other is applied to the pubes, the current being passed 
through the bladder for a quarter of an hour each day. The 
use of the Salt water bath with brick friction of the lower 
portion of the abdomen and perineum, will be found a valua- 
ble aid. In some cases much benefit will result from the 
application of a small fly-blister, alternately, to the hypogas- 
tric region and the perineum. 

"When dependent upon irritation the treatment will be 
directly opposite to that just named. Among internal reme- 
dies none will be found more useful than the Agrimonia, 
Hydrangea, Bromide of Potassa and Santonin. The irritating 
plaster applied to the hypogastric region is sometimes of great 
advantage, and it may be occasionally useful when applied to 
the lumbar spine. The bowels should be kept regular, and 
any cause of irritation in adjacent organs removed. If this 
does not seem to answer the purpose, I employ injections into 
the bladder of an infusion of Hydrastis or Cornus, or of 
Glycerin, or of Glycerin and Chlorate of Potassa. In the 
incontinence of urine in children, a biter tonic treatment, 
with Iron, and the use of the Salt-water bath. For the dis- 
ease itself, small doses of Belladonna and ^N~ux Vomica answer 
a good purpose, or Cubebs ma} T also be used. If it is at night, 
the child should be impressed with the necessity of getting 
up, and in a short time it will be found that they wake regu- 
larly, and the disposition to involuntary evacuation having 
been in this way removed, the child will eventually retain its 
urine all night. 



PASSAGE OF RElSrAL CALCULI. 

As already named, calculi sometimes form in the pelvis of 
the kidney and traverse the ureter to the bladder. If they 



Acute Cystitis. 351 

are round and smooth, their -passage may not he difficult ; hut 
if rough, as in the case of oxalate of lime, it is attended with 
the most exquisite pain. The pain commences in the loins, 
and passes in the course of the ureter to the bladder; it fre- 
quently extends to the testicle and down the thigh, and 
sometimes to the hip. It is attended with great prostration, 
there is nausea and vomiting, with sometimes colicky pains 
in the abdomen, and extreme restlessness. The pain is some- 
times so severe as to draw the patient double, and cause him 
to cry out with the intensity of the suffering. The descent of 
the calculus usually occupies from twelve to thirty-six hours, 
during which time the suffering continues, though not con- 
stant. Sometimes there is considerable hemorrhage during 
this period, and if the pain has been very severe we will find 
the patient with cold extremities, and a cold clammy sweat 
will break out during the paroxysms. 

Treatment. — Having determined from the location and 
character of the pain that it is probably owing to the pass- 
age of a renal calculus, we will place the patient in a warm 
bath, as hot as can be borne, and maintain the temperature of 
the water until temporary relief is obtained. Internally we 
may administer Chloroform in doses of ten or twenty drops 
every half hour or hour in Glycerin, and, if need be, use in 
addition some preparation of Opium. The Tinctura Opii 
Crocata, or McMunn's Elixir, are the preparations I prefer. 
In some cases, to favor action of the skin, we might use the 
Compound Tincture of Serpentaria; demulcent diuretics, as 
the Althrea or Hair-cap Moss, rendered alkaline by the addition 
of a small portion of Potash, will be found beneficial. When 
the patient is removed from the warm bath, hot fomentations 
should be continuously employed. If these means should not 
give relief, I would place the patient partly under the influence 
of Chloroform, and maintain its action until the calculus had 
passed. 



ACUTE CYSTITIS. 

Acute inflammation of the urinary bladder is not of fre- 
quent occurrence. It is usually caused by injuries, or from 
irritating diuretics or injections, or from disease of adjacent 
viscera, and more rarely from cold. It may be confined to 



352 The Eclectic Practice of Medicine. 

the mucous coat, or may involve both it and the muscular, or 
extend to the peritoneum. 

Symptoms. — Acute cystitis commences with pain in the 
hypogastric region, of a sub-acute character, with soreness on 
pressure. There is a frequent desire to urinate, and these 
calls are attended with an aggravation of the suffering. From 
the sympathy existing between the bladder and the kidneys, 
the urinary secretion becomes scant and high-colored, and its 
increased acridity gives rise to a painful brining and scalding 
sensation when it is passed. "When the disease has attained 
its greatest intensity, there is an almost constant desire to 
micturate, with an intense tenesmus, so that the patient is 
sometimes obliged to take hold of something with his hands 
when passing water, and will frequently bite his lips to keep 
from crying out with the severe suffering. 

"With the commencement of the pain the patient is usually 
seized with a chill or well-marked rigor, which is followed by 
febrile action, generally of a remittent character, and not very 
severe. The disease runs a course of from six to twelve days, 
and terminates in resolution, or the chronic form; or in some 
rare cases extending to the peritoneum and adjacent fascia 
gives rise to the formation of a pelvic abscess. 

Diagnosis. — Acute cystitis is readily determined by the seat 
of the pain, and by its aggravation during micturition, the 
change in the character of the urine and its difficult passage 
with tenesmus, is additional evidence. 

Prognosis. — The disease usually terminates favorably with- 
out any structural change, and except in cases in which 
inflammation extends to the adjacent tissues, there is but 
little danger. 

Treatment. — In this case we would administer the special 
sedatives with Gelseminum and a diaphoretic, a?, #, Tincture 
of Aconite, Tincture of Veratrum, aa, 3ss; Tincture of Gelse- 
minum, 3ss; Tincture of Asclepias, 3j; Simple Syrup, 3ijss; 
M. ; of which a teaspoonful might be administered every hour 
at first, until the influence of the remedies is marked, and less 
frequently afterwards. A brisk cathartic of equal parts of 
the Compound Powder of Jalap and Bi-tartrate of Potassa 
may be given immediately, and repeated if necessary. A 
mucilaginous diuretic, or an infusion of Marsh Mallows, Hair- 
cap Moss or Verbascum may be administered freely, and in 
some cases a small portion of the Acetate or Citrate of Potassa 



Chronic Cystitis. 353 

may be given with it, say to the amount of one or two drachms 
in the course of twenty-four hours. Instead of the remedies 
first named we might use, #, Extractum Conii, 3j; Potassii 
Bromidum, 3j; Tinctura Gelsemiui, 3ss; Tinctura Aconiti, 
3ss; Aqua, 3iv; M.; give in teaspoonful doses every two hours. 
The hot sitz bath should be freely employed, as it seems to 
give greater relief than other local applications. The patient 
may sit in a tub of hot water for two or three hours, and 
repeat it as many times a day; between the baths hot fomen- 
tations may be used. An enema of Tincture of Opium, Gel- 
seminum and Lobelia, with warm water, frequently gives 
marked relief. As the acute symptoms pass off we will resort 
to the more stimulating diuretics, as the Uva Ursi, with Macro- 
fcys, Buchu, Agrimonia and Collinsonia, 



CHROMIC CYSTITIS. 

Chronic inflammation of the bladder is of more frequent 
occurrence than the acute. It is almost always confined to 
the mucous coat, giving rise to the various changes of struc- 
ture noticed during chronic inflammation, as thickening of 
the mucous membrane, enlargement of the follicles, ulcer- 
ation, etc. Its causes are various; it may arise from cold, 
injuries, irritating diuretics or injections, the presence of cal- 
culi, irritation from diseases of the kidneys, extension of dis- 
ease from the urethra, as in gonorrhoea, and from extension of 
disease from adjacent organs. 

Symptoms. — Persons suffering from chronic cystitis usually 
complain of a sense of weight in the hypogastrium and peri- 
neum, with a dull, dragging pain. There is also tenderness on 
deep pressure over the hypogastrium. More or less difficulty 
is experienced in passing urine, sometimes on account of the 
increased mucus secretion, and at others from the seeming 
acridity of the urine. Tbe patient frequently complains 
of pain in the neck of the bladder, extending the entire length 
of the urethra, and sometimes of a sensation of scalding or 
burning referred to the region of the bladder. In severer 
cases, when complicated with disease of the prostate, or 
when ulceration has occurred, the pain and heat in the blad- 
der is very severe, the call to urinate urgent, and attended by 
violent tenesmus and straining. 
23 



354 The Eclectic Practice of Medicine. 

The general health becomes markedly affected when the 
disease is severe; the bowels are constipated; the appetite 
impaired; the skin dry, harsh and sallow; and considerable 
loss of flesh and strength. The urine varies greatly; in the 
milder cases it seems nearly natural, but in the more severe 
cases, it contains mucus, pus, and the phosphates. Sometimes 
it is so thick by the presence of these materials that it is 
voided with difficulty. 

Diagnosis. — Chronic cystitis is determined by the location 
of the pains and tenderness, and its association with difficulty 
in passing water, and alteration in the urine dependent 
upon the changed secretions of the bladder. Mucus in urine 
may be determined by its action on litmus paper, by its 
particles coagulating into a thin, semi-opaque membrane, 
on the addition of Nitric Acid, and by its soon under- 
going putrefactive decomposition, becoming ammoniacal. 
Pus in urine generally falls to the bottom when allowed 
to stand; Acetic Acid has no effect on it, but if agitated 
with Liquor Potassa? it forms a dense, translucent, gela- 
tinous mass. If the urine contains phosphatic deposits it is 
often very foetid, sometimes pale, at others greenish, and vis- 
cid from abundance of mucus. On placing some of the 
mucus beneath the microscope, abundant crystals of the 
triple phosphate are found entangled in it. Dr. Bird remarks 
that: "One point must be borne in mind in forming a prog- 
nosis from the state of the urine, viz., not to regard it as 
ammoniacal because the odor is offensive, and not to consider 
the deposit as purulent because it looks so. A piece of litmus 
paper will often show it to be neutral, and even sometimes 
acid, while microscopic inspection often proves the puriform 
appearance of the urine to be an admixture of the phosphates 
with mucus. For want of these precautions, I have seen 
some cases regarded as almost hopeless which afterward 
yielded to judicious treatment. It is quite certain that the 
mucous membrane of the bladder may, under the influence of 
chronic inflammation, secrete so much of the earthy phos- 
phates and unhealthy mucus as to render the urine puriform 
and offensive without having necessarily undergone any struc- 
tural change." 

Prognosis. — Though persistent in its character, the disease 
is almost always amenable to treatment. Cases in which there 
is enlarged prostate with ulceration of the bladder are the 



Chronic Cystitis. 355 

most intractable, and sometimes prove fatal. "When asso- 
ciated with chronic disease of the kidneys it is almost always 
fatal . 

Post-Mortem Examination. — In the milder forms of this 
affection, we find the mucous membrane thickened, injected 
and discolored, and its follicles enlarged. It is frequently 
softened so as to separate from the muscular coat with consid- 
erable readiness. In a still more advanced stage the entire coats 
are thickened and contracted, the mucous follicles enlarged ; 
and more or less ulceration, sometimes regular and well- 
defined, and at others irregular and sloughy. According to 
Copland, "When the ulceration is extensive the hypertrophied 
muscular fibers appear, and resemble the columns carnea of 
the heart, presenting a purplish-red color, the mucus coat 
between the columns thus formed being pale, soft and swollen. 
Pouches or sacks generally coexist, with dilated ureters, 
between these muscular columns, and are formed by the con- 
traction of the bladder and of the abdominal muscles in 
expelling the urine, forcing the mucous coat in places between 
the muscular fibres. These pouches are lined with a diseased 
mucous coat, which secretes an alkaline mucus, and are some- 
times the receptacles of a mortar-like matter, and finally of 
calculi, consisting generally of phosphate of lime. As the 
disease progresses it frequently extends to the ureters, pelvis 
of the kidney, and at last so involves its structure as to occa- 
sion death." 

Treatment. — The milder forms of chronic cystitis are fre- 
quently cured by the employment of tonic, astringent, and 
stimulant diuretics, and the judicious use of counter-irritants, 
I have employed the Essl. Tinctures of Agrimonia, Hydran- 
gea, and Collinsonia with marked success, sometimes adding 
the Santonine or Bromide of Potassa, if there was much 
burning or irritation. The Uva Ursi, Chimaphila and 
Buchu, are also employed with advantage in some cases. 
When there is greatly increased secretion of mucus, we may 
sometimes get good results from the use of Cubebs and 
Hydrastis, in doses of two grains of the first to ^ve of the 
last, four or iive times a day. Copaiba is sometimes found 
useful, as is also the Tincture of Cantharides. "When the 
irritation seems acute, I have employed the Conium with 
Black Cohosh, with marked advantage. In addition it is 
very essential that the bowels should be kept in a soluble con- 



356 The Eclectic Practice of Medicine. 

dition, and if there is any disease or cause of irritation of the 
rectum it should be removed. 

I have s^reat faith in the use of counter-irritation in these 
cases, though it will not do to rely on it to effect a cure in 
the worst cases. I prefer the irritating plaster applied low 
down over the hypogastrium, and continued so as to produce 
suppuration; if the patient complains of the back, or there is 
tenderness on pressure, I use it also there. Instead of this, 
dry cups and sponging with strong Salt water, answers a 
good purpose, or we may use the Croton Oil in strong stimu- 
lating liniments. 

The measures above named answer very well in the milder 
cases, and though we use them in the severer forms of the 
disease, we do not depend upon them. In such cases we 
resort to injections to remove morbid accumulations, and for 
their topical action. It is surprising to see the benefit that 
will result from simply washing out the bladder with tepid 
water, in cases of phosphatic urine with increased mucous 
secretion; the distressing tenesmus and burning pain and 
difficulty of passing water, all disappear, but return when 
this material again accumulates. In some cases the use of 
simple tepid water is all that is necessary, but in others we 
medicate the injection. If there is much irritability of the 
bladder, we might employ equal parts of Glycerin and Rose- 
water after the tepid injection ; or, #, Chlorate of Potassa, 
3j ; Glycerin, Rose-water, aa, 3ij ; and use one ounce as an 
injection; or, #, Zinci Sulphas, gr. xx ; Morphia Sulphas, gr. 
iij ; Glycerin, Aqua Rosee, aa, 3ij ; M. ; one ounce to be used 
as an injection, after washing the bladder out with tepid 
water, and if it produces too much burning, to be followed by 
the injection of more water to wash it out; Chloride of Zinc 
may be used as an injection in the proportion of one or at 
farthest two grains to the ounce of water. A decoction of 
Hydrastis or Cornus Florida has been used with success in 
many cases. 

The internal means just named should be employed with a 
tonic general treatment, and the secretions kept free- Among 
the most efficient agents that we have employed is the Agri- 
monia with Collinsonia, as, #, Essl. Tincture of Agrimonia, 
Essl. Tincture of Collinsonia, aa, 3ij ; Syrup of Prunus, 3iv; 
M. ; and give in doses of a teaspoonful every three or four 
hours ; a small proportion of Hydrastis added might be all 



Urinary Deposits. 357 

the tonic required. In severe cases an alterative is required, 
as the Compound Tincture of Corydalis, or Compound Syrup 
of Stillingia, or small doses of Poclophyllin, thoroughly tritu- 
rated with white Sugar. Occasionally we find it useful to 
employ Electricity, passing the current from the spine through 
the bladder. The injections of warm water are best used 
through a double gum catheter made for the purpose, so that 
the fluid may escape as it is being thrown in ; but usually a 
good sized silver catheter answers all purposes, as the syringe 
may be removed, allowing the water to pass out, and the 
injection thus repeated as often as necessary. 



URINARY DEPOSITS. 

"We may glance briefly here at those deposits from the 
urine that give rise to irritation of the urinary passages, and 
that when aggregated form calculi. Unless there is marked 
irritation of the urinary apparatus, or some lesion that is likely 
to be explained by an examination of the urine, this examin- 
ation is rarely made. The most frequent cause calling for it 
is the passage of small urinary concretions through the 
urethra. In these cases, in order to prevent their future for- 
mation, and especially to guard against calculus or stone in 
the bladder, we wish to determine the nature of the deposit, 
and thus adopt means to prevent it. Much more space should 
be given to the subject than we are able to devote here, but 
some of the more prominent facts may be stated. 

In a normal condition there is no deposit from the urine, if 
we except a slight amount of mucus and epithelial debris, 
which subsides upon the urine's standing. We have already 
noticed that during disease of the urinary organs certain 
material would be found in the urine, depending on the dis- 
ease for its origin. Thus, we have the elements of blood, red 
globules and albumen, mucus, epithelial cells, casts of the 
uriniferous tubules, and pus, and in certain diseased condi- 
tions of the bladder, the triple phosphate. Other deposits 
undoubtedly depend upon some lesion of the blood, nervous 
system, or the functions of digestion and assimilation. Being 
symptomatic in some cases, of grave changes in the system, 
they are worthy of notice on this account, as well as the irri- 
tation and disease of the urinary organs that they entail. 



358 The Eclectic Practice of Medicine. 

The principal deposits we have to notice are, uric acid and 
urates, oxalate of lime, cystine, phosphate of lime, ammonia, 
phosphate of magnesia, carbonate of lime, silicic acid. These 
deposits may occur in the form of minute crystals, or an amor- 
phous material, which is slowly deposited as the urine cools. 
Or the particles may be aggregated so as to form small masses 
from the size of a mustard seed to that of a cherry-stone, 
which is termed gravel; or it may be combined in masses 
varying from this to one or two ounces, and in some rare cases 
to six, eight, ten, or even sixteen ounces, under the name of 
urinary calculi. 

Uric acid, or as sometimes called lithic acid, is a natural con- 
stituent of the urine, but is found in small quantity, thirty- 
nine parts in a thousand of urine. It arises from the meta- 
morphosis of tissue, and, as Liebig contends, is the immediate 
product of the breaking down of all nitrogenized tissues by 
oxidation, and that urea is a secondary product, arising from 
the action of oxygen and water on it. This proposition is dis- 
puted by many eminent physiologists, but all admit the fact 
that its origin is from the waste of the tissues, and from 
imperfectly elaborated ingesta rich in nitrogen. It is usually 
excreted in health combined with ammonia or soda, as urate 
of ammonia, or urate of soda. Urine containing uric acid 
always reddens litmus paper, and its specific gravity is gener- 
ally above 1020. When an excess of acid is present, it lets 
fall crystals in cooling, though all is not deposited until 
decomposition has commenced. Very high-colored urine 
seldom deposits much uric acid, unless a stronger acid is 
added. We obtain the crystals for microscopic examination 
easiest by putting the urine in a bottle, letting it stand for 
some time, cork downward; by quickly turning it back and 
withdrawing the cork, the drop or two adhering to it is 
rich in the deposit. Lithic acid preseuts beautiful crystals 
under the microscope, usually rhomboidal in form; the urates 
are in the form of an amorphous sediment, either yellow or 
reddish in color, and redissolve on heating the urine. 

As regards the pathological signification of deposits of uric 
acid and urates, we find that they may sometimes be deposited 
in excess from intemperance in eating, from temporary irrita- 
of the stomach and other minor diseases interfering with 
digestion and assimilation. In other cases they undoubtedly 
depend upon some imperfection in the process of the retro- 






Urinary Deposits. 359 

grade metamorphosis of tissae. Dr. Bird remarks that: "Uric 
acid and urates may occur in great abundance in the urine, so 
as to be serious sources of irritation, and then especially 
become primary objects of attention as definite diseases. Still 
we must never forget that a mere deposit of urate of ammonia 
may be the result of causes hardly amounting to disease, and 
may be rather regarded as an evidence -of the integrity of the 
depurating functions of the kidneys than of their lesion. "We 
have frequently to disabuse our patients' minds of very erro- 
neous opinions they have entertained on that point, which 
have added very seriously to their anxieties b3^ apprehensions 
of impending disease. Uric acid and urates may be deposited 
in an insoluble form in the kidnej* or bladder, and aggregating 
form a mass, on which, by a kind of imperfect crystalization, 
great quantities of the acid or its salts may be deposited, giving 
rise to the formation of a calculus. Uric acid is of more seri- 
ous importance than most other elements of calculus forma- 
tions, not only from its constituting a large proportion of 
ill urinary calculi, but even when they are composed chiefly 
>f other ingredients^ the nuclei on which they are deposited 
are, in the great eaajority of cases, composed of uric acid. On 
account of its solubility, urate of ammonia is not a frequent 
component of entire calculi, although it often enters with other 
ingredients into their composition. Indeed, calculi wholly 
composed of this compound are almost peculiar to children. 
It is hence very probable that if we by medical treatment suc- 
ceed in overcoming a calculous diathesis, or dissolving a stone 
in the act of growth, it will be b} T means directed to the solu- 
tion of the uric acid and its ebnibi nations." 

The uric or lithic calculus, the most common of all forms, 
is of a brownish mahogany color, oval or flattened in form, 
and finely tuberculated or smooth, though not polished. It is 
perfectly . dissolved in caustic potassa, and disappears with 
effervescence in hot nitric acid, the solution affording, when 
evaporated to dryness, a bright carmine residue. It becomes 
black and is gradually consumed before the blow-pipe, leaving 
a minute quantity of white alkaline ashes. 

Treatment. — The principal indications in the treatment of 
uric acid deposit is to restore the normal action of the skin, 
correct any derangement of digestion, and give tone to the 
-stomach and bowels, and finally, by regular living, open air 
exercise, etc., get perfect assimilation of the food, and better 



36*0 The Eclectic Practice of Medicine, 

excretion of the detritus of the system. In addition, certain 
means are used to neutralize the uric acid, or so change it as 
to prevent deposit. Among all the measures, none seem more 
important than those directed to obtaining normal action of 
the skin, as an arrest of perspiration furnishes material for the 
formation of a deposit, by retaining in the blood elements that 
are capable of rendering uric acid insoluble. The frequent use 
of the warm bath seems to be adapted to many cases. It may 
be rendered tonic and bracing by the addition of common Salt, 
or, still better, by Carbonate of Potassa, or stimulant by the 
addition of Capsicum or Mustard. It should always be fol- 
lowed by brisk friction with the hand, a coarse towel, or the 
flesh brush; and the patient should invariably use a soft 7 
loose, but thick flannel next the skin, and the other clothing- 
should be warm. In place of the warm bath, the vapor bath 
maybe used: it may be extemporized by sitting the patient 
on a wooden-bottomed chair, with his feet in a bucket of hot 
water, and place another bucket of boiling water under the 
chair, and raising a sufficient quantity of steam by immersing- 
in it a hot iron or brick, a blanket being drawn closely around 
the patient and chair to prevent the escape of vapor. In some 
cases a cold sponge bath may be used, followed by rubbing- 
with a coarse towel or flesh brash. In some cases the bath 
should be rendered decidedly stimulant, by the addition of 
Capsicum, or tonic, by using* an infusion of the bitter tonics^ 
Means to restore the tone of the stomach, is of great im- 
portance, as by correcting- disordered digestion a double object 
is attained; the perfection of the primary assimilation of the 
food by which the entrance into the blood of a crude nitrogen- 
ized matter capable- of being converted into uric acid, is 
checked ; and the prevention of the generation of any acid y 
the product of unhealthy digestion,, which might be absorbed 
into the circulation,, reach the kidneys, and act as a precipi- 
tant of uric acid. — (Bird.) Various means will have to be 
resorted to as named under the head of dyspepsia. A bitter 
tonic, as an infusion of Hydrastis, Cornus or Populus, or 
other preparations of similar agents, with moderate doses of 
Carbonate of Potassa or Soda, and if necessary, a preparation 
of Iron, sometimes answer a good purpose. A pill of Nux 
Vomica and Hyclrastin, as heretofore named, answers a good 
purpose, and may be associated with an alkali. The Com- 
pound Powder of Rhubarb and Potassa^ in infusion^ or the 



Urinary Deposits. 361 

Compound Syrup of Rhubarb, accomplish all that is desired 
in some conditions. If there is any tenderness on pressure, 
or pain in the epigastric region, the irritating plaster should 
be employed until relieved. 

Careful attention to the bowels, to keep them in a soluble 
condition is necessary. The Podophyllin Pill: #, Podophyl- 
lin, gr. x; Leptandrin, gr. xx; Extract Conium, gr. xx; M. ? 
and make twenty pills, is usually sufficient, in doses of one or 
two daily, until the bowels are regulated. 

All this may be attended to, and yet if the patient is care- 
less as regards his habits, it will be of no avail. The most 
rigid attention to the quality and quantity of the food is 
imperative, and frequently of far more importance than 
medicine. It should be, to a considerable extent, of easily 
digested animal food, with such vegetables as are easily di- 
gested, but none that will produce acidity, or be long in 
digesting. It is better for the patient to eat too little, rather 
than too much, as a badly digested meal, from overloading 
the stomach, in a person suffering from gravel or calculi, will 
become a double source of mischief, by furnishing too much 
nitrogen, and giving rise to acid fermentation. Moderate 
exercise in the open air is indispensable to a proper perform- 
ance of the functions of the body, and especially of digestion 
and assimilation, and thus becomes a very important part of 
the treatment. 

Colchicum has been recommended in this case by several 
writers, and used with care may sometimes prove beneficial. 
Dr. Cooper ordered low diet, vegetable food, the warm bath, 
and Carbonate of Soda, or Potash, given three or four hours 
after taking a meal ; vegetable acids might be used, but every- 
thing liable to generate acids in the stomach was to be scrupu- 
lously avoided. Mr. A. Ure recommended Benzoic Acid, in 
doses of five or ten grains, three times a day, to prevent the 
formation of uric acid; and Dr. 0. Hees, as strongly recom- 
mended Citric Acid, which is undoubtedly of service in some 
rheumatic and gouty cases. The alkaline agents, especially 
Carbonate of Potassa and Socla r and the Acetate^ Citrate and 
Tartrate of the same, and Liquor Potassse, are the only agents 
that as yet have seemed to have any influence in lessening the 
size of the urinary concretions, and their action is doubtful. 

Oxaluria. — Oxalate of lime is the next most frequent 
deposit to uric acid and the urates, and is almost always asso- 



362 The Eclectic Practice of Medicine. 

ciated with, an excess of the last named agents. It is only 
recently that it lias been studied, as the crystals are so minute 
as to require the microscope for their examination; the 
formation of gravel being of rare occurrence. At first it 
was supposed to arise from the decomposition of sugar, but 
this idea was exploded when it was found not to be present in 
diabetes. Dr. Bird remarks, "From the symptoms presented 
in cases of this disease, there is no difficulty in proving to a 
demonstration the positive and constant existence of serious 
functional derangement of the digestive organs, especially the 
stomach, duodenum, and liver; and further, that the quantity 
of oxalic acid generated is, to a very considerable extent, 
under the control of diet; some articles of food quite free 
from oxalic acid at once causing the excretion of this sub- 
stance in very large quantities, whilst others appear to have 
the effect of nearly totally checking it. These circumstances 
alone, together with the emaciation so generally present in 
the disease under consideration, at once prove, that whatever 
be the immediate agent which causes the kidneys to secrete 
the oxalic acid from the blood, the primary cause must, as 
Dr. Prout has well and satisfactorily shown, be referred to an 
unhealthy condition of the digestive and assimilative func- 
tions." 

The specific gravity of urine in oxailuria is usually from 
1020 to 1030, and as before remarked in many cases it contains 
an excess of uric acid and urates, Pirate of ammonia being 
deposited on cooling and sometimes tinted by purpurin. 

The deposit of oxalate of lime occurs in the form of white 
glistening powder, which wheel examined u>nder the micro- 
scope it is found to consist of transparent octahedra, with 
sharply defined edges and angles. The best way of making 
the examination is, to allow a portion of the urine passed a 
few hours after a meal, to stand until cool, then decant off the 
major portion, and pour part of the remainder into a watch 
glass, when on applying heat the crystals of oxalate will be 
collected at the bottom. 

Oxalic calculi are next in frequency to the uric, they are 
generally of a dark brown color, rough and tuberculatecl, hard, 
compact, and imperfectly laminated. It is insoluble in the 
alkalies, dissolves slowly in nitric and hydrochloric acid, if 
previously well broken up, and under the blow-pipe expands 
and effloresces into a white powder. A variety of this species 



Urinary Deposits. 363 

is remarkably smooth, and of small size, and from its shape 
has been described under the name of hemp-seed. 

The symptoms of oxaluria are those of greatly depressed 
vitality. The appetite is irregular, and digestion imperfect, 
with well marked dyspeptic symptoms. The secretions are 
deranged, the skin being very susceptible to external impres- 
sions, at times dry and harsh, again soft and flabby and cov- 
ered with an unnatural perspiration ; the bowels are usually 
torpid and sluggish, and do not respond well to the action of 
medicine. The patient is low-spirited and melancholy, the 
temper is irritable, and there is great restlessness, and constant 
brooding over his condition. There is frequently a very disa- 
greeable sense of weight and pain in the loins and small of the 
back ; the urine is voided with increased frequency, and with 
more or less heat and scalding. The patient becomes greatly 
emaciated as the disorder advances, and frequently sinks into 
a state of confirmed hypochondriasis. If the disease goes thus 
far, some other portion of the system becomes the seat of 
disease, as the lungs, liver, bowels, etc., which carry the 
patient off. 

Treatment. — In the treatment of oxaluria, the most promi- 
nent indications are, to improve the general health, and to 
establish secretion from the other emunctories. As there is a 
condition of confirmed dyspepsia, this must be managed as 
heretofore named. I might here remark, that I have found 
the strong infusion of Peach-tree bark given in quantities of 
two teaspoon sful every three hours, and the Essl. Tincture of 
Collinsonia in half teaspoonful doses four times a day, very 
successful remedies in these cases. I frequently make a pre- 
scription as follows : #, Essl. Tincture of Collinsonia, Essl. 
Tincture of Cornus, aa, 3ij ; Extract of lux Vomica, gr. iij ; 
Alcohol, 3ss; Glycerin, 3j : Simple Syrup, 3ij; M.; and give in 
doses of a teaspoonful four or five times a day. The Hydrastis 
is a very efficient agent in some of these cases, as is also the 
Ptelea, Populus and Liriodendron. These remedies should in 
all cases be associated with the mineral acids, the Nitric being 
recommended by Dr. Prout, but a combination of one part of 
Nitric and two or three of Hydrochloric by others. If there is 
tenderness on pressure over the epigastrium, I would strongly 
recommend the irritating plaster. To overcome constipation 
of the bowels where it exists, we may employ the Podophyllin 
Pill, named under the head of uric acid, or the Powder of 



364 The Eclectic Practice of Medicine. 

Sulphur and Phosphate of Soda, named in preceding pages. 
The diet should be regulated with the greatest care, all agents 
that produce flatulence or acidity of the stomach being dis- 
carded, animal and vegetable food being used in about equal 
proportions. The same means to increase elimination from 
the skin, as in the case of uric acid, should be employed here, 
and especially should flannel be worn next to the skin, and 
warm clothing to protect the body against sudden changes of 
temperature. In many cases, all drinks but water will have 
to be excluded, and especially should wine, beer, and other 
stimulants be proscribed : a small portion of brandy being 
allowed, if absolutely necessary. 

Phosphuria. — A considerable quantity of phosphoric acid is 
excreted from the blood through the kidneys in health, usu- 
ally divided between four bases, soda, ammonia, lime and mag- 
nesia, all of which are either soluble themsejves, or rendered 
so by the presence of some acid, the presence of a very minute 
portion being sufficient for this purpose. 

It may also be deposited in a healthy condition of the sys- 
tem, as after eating, laborious exercise, and especially after 
severe mental labor, but the deposit continues for only a short 
time; where continuously deposited, it is always indicative of 
important functional, and sometimes of organic disease. Dr. 
Bird remarks that one general law appears to govern the 
pathological development of these deposits, viz : that they 
always exist simultaneously with a depressed state of nervous 
energy, often general, more rarely local in its seat. Of the 
former, the result of wear and tear of body and mind in old 
people, and of the latter, the effects of local injury to the 
spine, will serve as examples. "Three forms of phosphatic 
deposit may be named; the triple phosphate, phosphate of 
lime, or calcareous deposit, and the mixed deposit, a combina- 
tion of the two preceding. The first is almost always associ- 
ated, with dyspepsia, the digestive functions " being poorly 
performed, the patient irritable and restless, with loss of flesh 
and strength, so that he is fatigued by slight exertion. The 
urine is usually copious, of a light amber color, or in some 
cases it is dark, and of a high specific gravity, 1025 to 1030. 
The deposit of phosphate of lime occurs from urine secreted 
in large quantity, of low specific gravity, and readily decom- 
posed by the atmosphere. The mixed deposit usually occurs 
combined with a large quantity of mucus, the urine being 



Urinary Deposits. 365 

pale, foetid and depositing a thick mortar-like sediment on 
standing. It usually occurs in cases of injury, or severe dis- 
eases of the spine, organic disease of the kidneys and bladder, 
in the severe forms of dyspepsia, and in persons who have been 
exhausted by severe mental labor, anxiety, night-watching, 
and during the progress of some cachectic affection that 
debilitates the system. The symptoms are those of imperfect 
digestion, mal-assimilation and nutrition, and disordered in- 
nervation. 

Deposits of the phosphates are always white, unless colored 
with blood, are insoluble in ammonia or liquor potassa, but 
soluble in dilute hydrochloric acid. In a majority of cases 
urine depositing much of the phosphates is alkaline, though 
they are deposited when it gives an acid reaction with litmus 
paper, but in this case the acidity does not depend upon free 
acid, but upon neutral salts. This deposit often settles to the 
bottom, like a thick cloud of mucus, for which it is frequently 
mistaken; we may at once detect their true nature, however, 
by the addition of hydrochloric acid, which dissolves the 
phosphates but does not affect the mucus. \Vhen examined 
by the microscope, the triple phosphate presents beautiful 
crystals, of the form of triangular prisms, small stellate con- 
cretions, and peniform crystals. The phosphate of lime 
does not occur in crystals, but occasionally in irregular crys- 
talized masses. Calculi of phosphate of lime are not of 
frequent occurrence, but it sometimes forms alternate layers 
with other matter. When it occurs it is usually small, of a 
pale-brown color, of a loosely laminated structure, not fusible 
with the blow -pipe, but readily soluble in hydrochloric acid 
without effervescence. The ammoniaco-magnesian calculus is 
of a white color and friable, looking a good deal like a mass 
of chalk ; it exhales an ammoniacal odor before the blow- 
pipe, is not affected by caustic potassa, but is easily dissolved 
in dilute acids. Another form of phosphatic calculi has been 
denominated fusible; it is white, extremely brittle, easily 
separated into layers, and leaves a white dust on the fingers. 
It is not affected by caustic potassa, is soluble in hydrochloric 
acid, and is melted into a transparent pearly glass under the 
blow-pipe. Both these last forms often attain an immense 
size, and frequently form incrustations on foreign bodies. 

Treatment. — The general treatment will be somewhat simi- 
lar to the other forms. The bitter tonics and iron, to improve 



366 The Eclectic Practice of Medicine. 

digestion and the quality of the blood, should be steadily 
employed. In some cases there seeing to be such a loss of 
tone on the part of the stomach, that tonics have no effect; in 
such cases I direct an emetic two or three times a week with 
the happiest results. As in the case of oxaluria I have ob- 
tained most excellent results from the use of !NTux Vomica and 
Strychnia, and the Collinsonia and Agrimonia ; Quinia to the 
extent of from four to eight grains a day, is often of marked 
benefit. 

The urine should be kept acid to prevent a deposit, and for 
this purpose dilute Citric Acid is most frequently used. The 
bowels should be kept in a soluble condition, as heretofore 
named, and strict attention given to the skin, and its secretion 
favored by the use of the bath, friction, and wearing flannel 
and warm clothing. The diet should be carefully selected, 
plain, but generous, and to a considerable extent of ani- 
mal food. 



ElIEUMATISM. 367 



CHAPTER VI. 

DISEASES OF THE ORGANS OF LOCOMOTION. 

Under this head we may include all affections of the motor 
apparatus, the bones, articulations, and muscles, with the 
various tissues that enter into their formation, or are con- 
nected with them. Most of these affections are quite painful, 
and some very serious. They are more annoying on account 
of the difficulty of motion ; and frequently the impossibility 
of keeping the structure at rest, is one of the most serious 
parts of the disease. 



RHEUMATISM. 

Rheumatism has been variously classified — sometimes as a 
disease of the blood, at others as involving principally the 
nervous system, again as arising from deficient secretion, 
and lastly, from an imperfection in the process of digestion 
and assimilation, Undoubtedly all of these elements aid in 
making up the disease, as we have now sufficient evidence 
that it depends upon some material (lactic acid), generated 
during digestion in some cases, and in others produced during 
the breaking down of tissues; that this impairs the quality of 
the blood and unfits it for the performance of its proper func- 
tions ; that its non-removal by the excretory organs is 
dependent upon their impairment; and lastly, that these 
associated, produce disordered innervation, and when the 
material is deposited in the tissues it sets up a peculiar form 
of inflammation which we term rheumatism. 

Four forms of rheumatism may be distinguished, though 
they run into one another, and sometimes rapidly change 
from one to another. They are, rheumatic fever, acute 
inflammatory rheumatism, sub-acute rheumatism and chronic 
rheumatism. The causes of rheumatism are, cold from sud- 
den changes of temperature — arrest of secretion from other 
causes, imperfect digestion, and causes that depress the 
nervous system. 



338 The Eclectic Practice of Medicine, 

Symptoms. — Rheumatic fever, usually makes its appearance 
after exposure to cold, followed by sudden arrest of secretion. 
It is ushered in with a marked chill or rigor, lasting from one 
to six hours, during which time, the patient not only com- 
plains of being cold, but of pain in the back and head, and a 
dull aching and soreness in all parts of the body. The fever 
that follows is usually high ; the skin hot, but frequently 
slightly moist : the pulse hard, and from 100 to 120 beats per 
minute; the tongue coated white; appetite lost; sometimes 
nausea and vomiting; bowels constipated, and urine scanty 
and high-colored. These symptoms usually increase up to 
the second or third day, when the fever is very intense; after 
this it continues without change up to the fifth, seventh, or, 
in some cases, the fourteenth day. There is more or less pain 
in all parts of the body, and sometimes we find it locating 
temporarily in the joints of the fingers, wrists, elbows, knees 
or feet,, sometimes continuing very steadily in one or two 
places, but rapidly changing in others. Usually the swelling 
in these cases is not very marked, but sometimes the contrary 
is the cause when the local affection resembles the next form 
of the disease. Occasionally the fever runs so high as to pro- 
duce delirium, which is followed by prostration, and a low 
typhoid condition. 

Acute inflammatory rheumatism, almost always commences 
with a chill, sometimes with a marked rigor, and following 
this more or less marked febrile action. In some cases we will 
find the fever running as high for three or four days as in the 
preceding case, being remittent in form, with evening exa- 
cerbations and morning remissions; it gradually subsides after 
this, until it is only marked in the evening. In other cases 
the fever is not very severe from the commencement, seeming 
to depend more on the local disease than on any general or 
systematic cause. 

The pulse is usually broad, open and bounding, and from 90 
to 110 beats per minute ; all the secretions are arrested, the 
skin in some cases being harsh and dry, in others hot but 
moist, with someimes profuse secretion; the tongue is covered 
with a whitish coat, the mouth is dry and the appetite very 
poor, or entirely gone. 

With the coming up of febrile action, and sometimes before, 
the local affection becomes manifest; most usually the disease 
affects the large joints, frequently the smaller ones — as of the 



Rheumatism. 369 

fingers, and in some cases a group of muscles, as of the calf of 
the leg, the muscles of the thigh, abdomen or arm : and again 
we find it confined to aponeurotic expansions, as the dorsum 
of the foot or hand, or the plantar and palmar surfaces. 

If a joint is the seat of the disease it becomes swollen, red, 
hot and painful; the pain being most acute, tearing, burning, 
gnawing, tensive or lancinating. It is not usually constant as to 
intensity, but comes on in exacerbations, in which the intensity 
of suffering is so great as to make the patient cry out. In other 
parts, the swelling seems to be a mere puffmess of the part, 
though usually the part is exquisitely tender. The local lesion 
is so severe, that the part is rendered entirely useless, the 
slightest movement aggravating the pain, and the patient can 
not bear the slightest pressure, even of the bed clothes. In 
some rare cases the part does not seem red, but more or less 
blanched. 

As the local affection progresses in some cases, the swelling 
increases, as well as the tenderness, until it seems that the part 
can not get larger. Very often, however, we find the local 
disease changing its location, and shifting from joint to joint, 
and from part to part, and seeming to be lit up in its new 
location in a few hours to its original intensity; this is termed 
a metastasis of the disease. The part left is not -by any means 
well, though the pain has disappeared, and the swelling and 
redness is to a considerable extent gone; there is still some 
tenderness on pressure, and the part is weak and useless, 
regaining its strength slowly. 

The disease lasts a variable length of time: in some cases it 
may be arrested in three or four days, in others from the sev- 
enth to the fourteenth day; and if allowed to run a regular 
course without interference saving good nursing, it will termi- 
nate usually from the second to the sixth week ; and in severe 
cases it may run this long or longer, under the best of treat- 
ment. During its progress we may expect great variation in 
the general as well as local symptoms ; the fever at times ' 
becomes more intense, and is attended with disturbance of the 
nervous system, sometimes amounting to delirium. The dis- 
ease gradually declines, the fever passing off, and the pain, 
swelling and redness slowly leaving the parts affected. Even 
when the pain has ceased, and the XDarts have resumed to a con- 
siderable extent their former condition, they are still very 
24 



370 The Eclectic Practice of Medicine. 

weak, and marked twinges give notice that they are not yet 
in a state to bear rough usage. 

In sub-acute rheumatism, there is usually but little fever; the 
pulse may be increased five or ten beats per minute, and be 
more full and bounding, or hard, the skin harsh and dry, the 
tongue coated, the appetite somewhat impaired, bowels con- 
stipated, and urine scanty and deeper colored. These symp- 
toms follow instead of preceding the local affection. One or 
more parts may be affected, the larger joints suffering most 
frequently, the smaller ones next, and the aponeurotic expan- 
sions and muscles least. When a part is attacked, it commences 
to swell and becomes hot and. painful, though in many cases 
it is not reddened. The pain, as iu the preceding case is gnaw- 
ing, tearing, tensive and contusive, or lancinating, though 
usually not so severe as in the acute form. It does not change 
its position so frequently, but still a metastasis is not uncom- 
mon. It is full as stubborn as the more acute malady, and in 
fact I prefer to treat the more acute forms of the disease. 

We have heretofore seen that rheumatism may attack the 
heart by metastasis, and that this is one of the most severe 
complications of the disease. It is evidenced by the feeling 
of oppression at the praecordia, pain of a lancinating, tearing 
character, and faintness, more or less difficulty of breathing, 
anxious countenance, and the small and rapid pulse — symp- 
toms which can not very readily be misunderstood. Rheuma- 
tism may affect the eye, producing rheumatic ophthalmia, or 
the structures of the ear, the brain, the membranes of the 
spinal cord, and the sheathes of the nerves, and to some 
extent the stomach and alimentary canal. 

Diagnosis. — We have but little trouble in making the diag- 
nosis of rheumatism, the swelling, heat, and peculiar charac- 
ter of the pain being generally sufficient. It is true, that in 
cases of disease of the bones, or of the cartilages or synovial 
membrane of a joint, it is sometimes almost impossible; yet 
the character of the pain, the general condition of the system, 
and the fact that rheumatism is rarely confined to one point, 
will frequently enable us to decide. Rheumatism of the back, 
or lumbago, is sometimes mistaken for disease of the kidneys 
or spinal cord; but if we recollect that in disease of the kidney 
we will usually have retraction and pain in the testicle, change 
in the character of the urine secreted, and more or less con- 
stitutional disturbance, peculiar to suppression of urine; and 



* Eheumatism, 371 

that in disease of the spinal cord to this extent, we would 
have disturbance of all the nerves given off below, we will not 
readily make the mistake. Neuralgia is very frequently con- 
founded with rheumatism, and it is sometimes almost impossi- 
ble to distinguish them; but in a majority of cases, the pain 
being exquisitely sharp, tearing or lancinating, and in the 
course of a nerve, will enable us to see that it is neuralgia. 

Prognosis. — The prognosis in rheumatism is almost always 
favorable, and in the exceptional cases the danger is more 
from the complication or metastasis than the original disease. 
But when we come to determine the time that the disease will 
last, we find ourselves in the dark. It runs a very variable 
course if not treated, is sometimes very amenable to reme- 
dies, and in others Is not favorably affected by any measures 
adopted. 

Post-Mgrtem Examination. — If located in the articulations, 
we find them swollen and exhibiting evidences of inflamma- 
tion. The principal enlargement is eaused by effusion into 
the cavity of the synovial membrane, which is usually slightly 
thickened, and in some cases the articular cartilages are soft- 
ened. The synovia frequently differs from its healthy condi- 
tion by being more viscid, whitish, or having more or less 
flocculent material floating in it. If the muscles or tendinous 
aponeurosis were affected, we may or may not have the evi- 
dences of inflammation in addition to the swelling. If the 
serous membrane, the pericardium, pleura, or membranes of 
the spinal cord, are the parts diseased, we will generally find 
evidences of inflammatory action, and more or less effusion, 
with adhesions or coagulable lymph on the free surface, or 
flocculi in the fluid effused. 

Treatment. — In rheumatic fever, I usually commence the 
treatment with the use of the special sedatives, as, #, Tinc- 
ture of Veratrum, 3ss; Tincture of Aconite, gtt. xx; Water, 
3iv; M., and give in doses of a teaspoonful every half hour, 
or hour, until the patient is entirely relieved. Associated with 
this, to stimulate the skin and kidneys to action, I order Essl. 
Tincture of Asclepias, gj ; Saturated Tincture of Macrotys, 
5ss; Nitrate of Potassa, 3ij ; Water, 3ij ; Simple Syrup, 3ss; 
in doses of a teaspoonful every two hours. It is better to 
leave the Nitrate of Potassa out of the prescription, and give 
it in weak solution to the extent of two or three drachms in 
the twenty-four hours. These means are aided by the employ- 



872 The Eclectic Practice of Medicine. 

ment of the aleoholk vapor bath, or the common yapor bath; 
or the use of the warm bath, or simple sponging with warm 
water rendered alkaline by the addition of Carbonate of 
Potassa. In some cases we might employ the spirit vapor 
bath, and an active diaphoretic,, as the Compound Tincture ot 
Serpent-aria, packing the patient warmly ua bed after the bath, 
with bottles of hot water to the extremities, to keep up per- 
spiration. Or we might rely on a nauseant diaphoretic, with 
an alkaline diuretic, as, R, Asclepias, Eupatorium, aa, 3j; 
Sanguis aria, 3ij ; titrate of Potassa, 3ij; pulverize finely and 
thoroughly mix. This may be given in doses of from half to 
one drachm, in warm water, every two or three hours, until it 
prodiices nausea, and then in smaller doses to keep up diapho- 
resis. It may be assisted by the hot foot bath, or vapor bath, 
and in certain cases will act speedily and give the greatest 
satisfaction — the only objection to it being on account of its 
bulk. In some cases where there is an undue tenseness of the 
system, with great suffering from wandering pains, or irrita- 
tion of the stomach, we will find it good practice to premise 
all treatment with a thorough emetic. The bowels may be 
kept open through the course of the treatment with the Podo- 
phyllin Pill. 

Usually as soon as the pulse is brought down, we may ad- 
minister Opium at night, to quiet pain and induce sleep; from 
one to three grains being required for the purpose; Morphine 
seems to irritate the stomach. As soon as secretion is estab- 
lished, we find it important in many cases to employ Quinia, 
giving it during the morning remission in quantities of from 
eight to twelve grains, and repeating it daily, until the fever 
is arrested. 

In acute inflammatory rheumatism, a very similar treat- 
ment is pursued in the first stage. We may employ the 
special sedatives, with diaphoretics, and an alkaline diuretic, 
as there named ; or, we may first give an emetic, followed by 
a moderate cathartic, and then the sedatives, and measures" to 
promote secretion. I have seen most marked beneficial results 
follow the administration of a thorough emetic in severe cases 
of this kind ; and it seems to prepare the system for other 
medicines. The action of Asclepias and Macrotys is very 
marked in some of these cases, following the use of the 
special sedatives, or sometimes without them. 

The saturated Tincture of Macrotys may be given in doses 



Rheumatism. 373 

of from twenty to forty drops, with an equal quantity of the 
Asclepias, and repeated every two hours, until it produces a 
feeling of pain and heaviness in the head. I have used the 
combination of Asclepias and Eupatorium, mentioned in a 
preceding page, with the most marked advantage. The vapor 
bath, and warm bath is associated with these means as in the 
preceding case. Of the alkaline diuretics, I prefer the Citrate 
of Potassa, to the extent of three drachms daily, with a tea- 
spoonful of Lemon-juice, every two hours; if the Citrate is 
not readily obtained, the Acetate may be used in its stead. 
The secretions being free, there is no trouble in using Opium 
to quiet the pain, and if there is periodicity, Quinia is some- 
times a very effective remedy, 

I have been tempted to believe that in some cases the ad- 
ministration of a simple solution of Carbonate of Potassa, 
and its local application, the part being kept warm, and the 
iise of a sufficient quantity of Opium to quiet pain, the 
bowels being kept open with the Podophyllin Pill, would 
answer a better purpose than any other treatment The 
Tincture of Xanthoxylum, taken internally and locally applied, 
has answered a good purpose in cases where there was unnat- 
ural perspiration. 

As regards local applications, they are sometimes useful in 
relieving pain, but at others seem to have no effect. Various 
remedies are employed, stimulant, narcotic, sedative, rube- 
facient, etc., and there are no means of determining in a given 
■case, which will prove the best; equal parts of Aqua Ammo- 
nia and Olive Oil answers a good purpose as a stimulant when 
applied by friction, and as a rubefacient when covered to 
prevent evaporation. A most excellent liniment for rheuma- 
tism may be extemporized by ordering, #, Aqua Ammonia, 
Sij ; Olive Oil, 3ij ; Chloroform, Tincture Aconite, aa, 3jss; 
M.; shake thoroughly when using and apply with flannel. 
The common Chloroform Liniment, B-, Tincture of Aconite, 
Chloroform, Oil of Sassafras, Alcohol, aa, 3j ; M.; is a very 
good application to relieve pain ; equal parts of the Tinctures 
of Phytolacca, Stramonium and Belladonna, continuously 
applied, or the application of a warm decoction, is sometimes 
very useful in articular rheumatism; hot applications of any 
kind give relief in some cases, but in others seem injurious, 
and may be well replaced by cold water. Indeed it has been 
recommended to apply a bladder filled with ice and salt, 



374 The Eclectic Practise of Medicine. 

to the inflamed part as a means of arresting pain and diseased 
action, and though I do not doubt its efficacy in some cases, 
I would fear destruction of tissues from its indiscriminate use. 
A simple solution of Carbonate of Potassa in some cases, and 
wrapping with cotton wool, or as I prefer, wool itself, is 
many times preferabk to any of the many liniments made use 
of. If there is great tumefaction and pain in consequence, 
the use of cups at a short distance from the diseased part, 
may be useful. 

I am satisfied that woolen clothing is of great importance 
in the treatment, and if possible get my patient divested of 
every thing cotton, aisd in bed between blankets; perfect 
quietude should be maintained, especially of the part affected, 
as rest is an important element of cure. 

The patient may be- permitted to drink freely, and allowed 
a moderately full diet, if well digested. If a stimulant is 
necessary, native wine will usually be found the best. All 
complications must be met as they arise, in the manner laid 
down under their proper heading, and especially should the 
physician be on the lookout for the first symptoms of cardiac 
disease. 

In sub-acute rheumatism, we will in many cases obtain most 
marked results from the use of the Tincture of Macrotys. 
For an entire season, I did not have occasion to resort to any 
other remedy, if we except means to keep the bowels in a 
soluble condition, and an opiate to relieve pain. So marked 
was its effects, that I had nearly concluded that it was a spe- 
cific; it has failed me in many cases since, but I yet consider 
it a valuable remedy. A very good combination in these 
cases, is #, Extract. Conii, 3j ; Potassii Iodidum, 3ij ; Tinctura 
Stramonii, 3ij ; Aqua, iv; M., and take a teaspoonful four 
times a day. Colchicum may be used with advantage in some 
cases, especially where associated with gout ;, I use the English 
tincture of the seeds, in doses of from ten to thirty drops 
every three hours. A solution of Citrate of Potassa, so that 
two or three drachms will be taken in the course of twenty- 
four hours, with the addition of Lemon-juice in some cases, 
answers a very good purpose. The local applications may be 
the same as in the preceding case. 



Chronic Rheumatism. 375 

CHRONIC RHEUMATISM. 

Chronic rheumatism most frequently results from the acute, 
or sub-acute form, but in some cases may be slowly developed 
independently of them. In some cases it has its origin in 
imperfect digestion and assimilation, which we would readily 
account for, on the theory that an increase of lactic acid was 
the cause of the disease. In others it seems to have arisen 
from, and is dependent on deficient action of the excretory 
organs, and possibly on some change in the process of retro- 
grade metamorphosis, by which the broken down tissues are 
converted into material fit for excretion ; and in others, upon 
some derangement of innervation. It is true that all this is 
speculative and not proven, but we have good reasons for 
these opinions. Acting on them in the administration of 
remedies, we find ourselves successful, so far as the general 
disease is concerned, but not always with the local malady. 

Symptoms. — As regards the general health of the patient, 
we find it varies greatly in different cases. In some there is 
manifest derangement of the stomach, various unpleasant sen- 
sations, as of fullness, pain, acidity, flatulence, etc., occurring 
after a meal, and showing that digestion is not well 
performed. In such cases we find the patient reduced in flesh 
and strength, and exhibiting evidence of marked general 
cachexia. In others the secretions are manifestly at fault, the 
kidneys acting poorly, or the skin is harsh and dry, or relaxed 
and flabby, and the bowels irregular. It is true that we find 
cases of chronic rheumatism, in which we can not detect the 
slightest lesion, except the local rheumatic disease, what loss 
of flesh and strength there is being attributable to the con- 
tinued suffering and loss of rest resulting from it ; metastasis 
occurs in the chronic as well as the acute disease. 

It most frequently affects the articulations, they being 
swollen, tender and painful ; one or more may be affected 
at the same time, usually not more than two, and the 
amount of swelling, discoloration and pain, varies in dif- 
ferent cases; sometimes the tenderness and pain are exquisite, 
at others it is not very marked ; the articulation is in some 
cases entirely useless, motion or pressure giving rise to severe 
suffering ; at others, though lame, it may still be used. In 
some cases it takes the form of synovial dropsy, it being very 



376 The Eclectic Practice of Medicine. 

evident that the enlargement is almost entirely dependent 
upon effusion into the joint. At others the enlargement 
seems to be dependent npon material within the synovial 
membrane, but it is not nearly so mobile as before. In other 
cases there is marked enlargement of the articular extremities, 
or a dull, heavy, gnawing pain, with great tenderness, when 
the bones are placed so as to give rise to pressure on their 
extremities. In other cases the deposit is undoubtedly outside, 
involving ligaments, tendons and muscles, that pass between 
the two bones, causing relaxation in some cases, contraction in 
others, thus giving rise to deformity. In some cases this is 
very marked, bones being dislocated, or tendons so shortened 
as to produce unnatural flexion or extension, or to change 
the position of the bones, as in the case of the knee joint, the 
articulation of the tibia being so changed as to produce 
knock-knee, and turn the toes outward ; or, in the case of 
lumbago, or rheumatism of the dorsal or lumbar portions of 
the spine, giving rise to spinal curvature and other distor- 
tions. If it attacks a group of muscles, we may find them 
gradually shortening, until a limb is rendered entirely useless, 
as in the case of contraction of the ham-string muscles, and 
flexion of the knee, and finally terminating in the almost 
entire change of the muscular structure. 

Diagnosis. — In some cases the diagnosis is not difficult, the 
rheumatic symptoms being well developed, but in others it is 
almost impossible to distinguish between this and other dis- 
eases of the articulations, especially if but one joint has been 
affected. We may, as a general rule, say, where more 
than one articulation is affected during the continuance of the 
disease, that it is rheumatism; if but one, and there arc no 
general symptoms to be depended upon, especially if the 
patient has not been subject to rheumatism previously, that it 
is some other affection. 

Prognosis. — The prognosis is not always favorable in chronic 
rheumatism, though it is so in a majority of cases. It is true 
that the disease has but little tendency to a fatal termination, 
unless it results in suppurative inflammation of the larger 
articulations, yet there is in many cases such change of struc- 
ture that it is impossible to effect a cure, and in some cases 
the constitutional affection seems to be dependent upon causes 
beyond our reach. 

Post-Mortem Examination. — When the joints have been 



Chronic Rheumatism. 377 

the seat of the disease, we find them variously altered. In 
some cases there seems to be nothing but an increase of the 
synovia; in others the synovial membrane is thickened, espe- 
cially the false ligaments, in some cases roughened, covered 
with, shreds of false membrane, or adherent, coagulable lymph, 
and the synovia more or less viscid, shreddy, and in some cases 
purulent. The articular cartilages are sometimes softened, at 
others eroded, and in some cases completely destroyed. The 
articular extremities of the bones are not unfrequently en- 
larged, and the ligaments, tendons, and muscles contracted or 
relaxed. When affecting other parts, if of long duration, it 
may so change their structure as to leave little resemblance to 
their original condition. 

Treatment. — The general treatment of chronic rheumatism 
will have to be varied to correspond with the symptoms in 
each case. If the digestive apparatus seems to be promi- 
nently affected, the means recommended under the head of 
dyspepsia will be appropriate. It must not be forgotten that 
imperfect digestion lies at the root of very many cases, and 
we can only get rid of the tendency to rheumatism by correct- 
ing these derangements. It is very essential to make the diag- 
nosis between chronic rheumatism affecting the entire system, 
and that that has become exclusively local. In the first case 
I have obtained marked advantage from the use of an emetic 
repeated twice or three times a week; it seems to rouse the 
entire system, and give free circulation to the blood, and 
improve all the functions. The bitter tonics and Iron are 
indicted in all cases where there is a tendency to ansemia, or 
where there is want of tone in the digestive apparatus. The 
vegetable and saline alteratives are alw y ays useful, though in 
some cases their effects are not as speedy as in others. I 
would recommend the Extract of Conium, with Macrotys 
and Iodide of Potassium, as, #, Extract of Conium, 3j ; Tinc- 
ture of Macrotys, 3j; Iodide of Potassium, 3ij; Aqua, 3iv; M., 
and give a teaspoonful four or five times a day. The Com- 
pound Syrup of Stillingia, with Iodide of Potassium, or Com- 
pound Tincture of Corydalis, with the same, act well in cases 
of long-continued local disease. The Tincture of Phytolacca 
and Corydalis, with a small portion of Stramonium, is very 
good. Sometimes the Tincture or Wine of Colchicum gives 
good results, as does also equal parts of Tincture of Ascle- 
pias, Gelseminum, and Macrotys, in teaspoonful doses every 



378 The Eclectic Practice of Medicine. 

three or four hours. In many cases I prefer a simple solution 
of Acetate or Citrate of Potassa, in addition to the measures 
called for by the derangements of digestion. 

The Propylamin has been highly recommended in rheuma- 
tism, and urged as a specific in all forms. I have tried it to a 
considerable extent, and have found it of advantage in some 
cases of the sub-acute and chronic forms of the disease, in 
which it may be used. The local applications made use 
of are various, all the measures heretofore recommended 
being used in these cases. My favorite application is the 
irritating plaster, directly to the diseased part, though not 
carried so far as to produce suppuration. In some cases it 
seems to produce a marked influence, even before redness has 
been induced. A poultice of a decoction of one part of Podo- 
phyllum to three parts of Cornus, thickened with Wheat-bran, 
or a poultice made with the Phytolacca is sometimes useful, as 
is also the application of a plaster of Belladonna. When the 
joints are seriously diseased during the progress of rheuma- 
tism, they may be treated as hereafter named. Among the 
external applications to increase the tone of the skin, the 
cold water bath has answered my purpose better than any- 
thing else; occasionally cases will be met with in which great 
benefit will be derived from the warm bath, or the vapor bath, 
and in others by the use of the cold douche. Electricity has 
been advantageously employed for the relief of pain, the cur- 
rent being passed from the part to the spine, and for the pur- 
pose of stimulating absorption passed in the opposite direction. 



PERIOSTITIS. 

Inflammation of the periostium is sometimes rheumatic in 
its origin, at others it arises from constitutional syphilis, and in 
some cases it is the result of cold or of injury. In either case 
it is a true inflammation, resulting in change of structure ; 
thickening, deposit beneath it, and finally suppuration, most 
usually next the bone. Being the nutritious membrane of the 
bone we find that it occasions disease of that, if its change of 
structure is sufficient to impair the circulation, or if it is sep- 
arated by the formation of pus; it is almost always accompa- 
nied by swelling of the superimposed parts, which frequently 
seem to partake of the inflammation. 



Periostitis. 319 

Symptoms. — The first evidence of the disease is usually a 
deep seated soreness and aching of the part, which is increased 
by motion. If extensive and, acute, chills and rigors now 
make their appearance, followed by brisk febrile action, the 
pulse being especially hard, and the patient irritable and rest- 
less. The fever is usually of a remittent form, the exacerba- 
tions coming on in the afternoon. In some cases the fever 
goes down in three or four days, nothing being left to mark it 
but the slightly accelerated and hard pulse, and deranged 
excretions. In others it assumes an ataxic or irritative charac- 
ter, attended by many of the symptoms heretofore named as 
typhoid, and running a course of from three to six weeks. In 
eases where but a small portion of the periosteum is affected, 
the inflammation being mild, but little febrile action is noticed. 

As before named, a sense of soreness and aching usually 
precedes the chill, when the fever comes up, the inflammation 
is fully developed ; there is a deep seated, tense, contusive pain, 
sometimes seeming as if the part would be torn to pieces, by 
some internal pressure. If the bone is superficial, the parts 
above are involved in the inflammation, become swollen, red 
and glistening, hot, and painful. If deep seated, as when the 
shaft of the femur, or the fibula, or posterior surface of the 
tibia are involved, there may be but little external evidence of 
the disease. Usually, there is a glistening appearance of the 
skin, with increased heat. 

The inflammation runs a variable course, sometimes rapid, 
sometimes slow. The symptoms continuing, and usually 
increasing in intensity, the patient complains of deep seated, 
throbbing pain, much more severe than that which preceded it, 
rigors occur, and the patient is much prostrated, indicating the 
formation of pus. After long and protracted suffering, the 
pus makes its way through the structures to the surface, and 
discharging, the pain is much modified. One or two, or four, 
six or eight weeks, may be consumed in this process, and 
sometimes resulting in most serious structural lesion of the 
bone. 

Diagnosis. — We diagnose periostitis, by the deep seated 
aching or tearing pain, increased when pressure is made 
directly upon the bone. The surface has usually a smooth, 
glistening appearance, that is unnatural in other cases. Fur- 
ther than this, the diagnosis must be made by exclusion. The 



380 The Eclectic Practice of Medicine. 

deep throbbing pain, extremely severe, with rigors or chilly 
sensations, determines the formation of pus. 

Prognosis. — The prognosis is favorable, except in cases 
where it is the result of secondary syphilis, and the general 
health is much broken. 

Post-Mortem Examination. — The periosteum is found thick- 
ened, and reddened in the early stage of the disease, and 
there is more or less effusion into the superimposed tissue, and 
sometimes beneath the membrane, the bone sharing in the 
inflammation to some extent. In a further advanced stage we 
find the membrane softened, with purulent formation on its 
free surface, and involving the adjacent tissue ; or, it is sepa- 
rated from the bone by purulent formation, and in some cases 
there is commencing caries, or, in others, death of a con- 
siderable portion of the bone. Advancing further, we simply 
find evidence of disease of the bone, which becomes the per- 
manent disease. 

Treatment. — If there is fever, give the patient the special 
sedatives as heretofore recommended, and a diaphoretic and 
diuretic. The Asclepias or Eupatorium will answer a good 
purpose as a diaphoretic, and may be aided by the Diapho- 
retic Powder of the Dispensatory; the diuretic should be 
Acetate or Citrate of Potassa. To favor the action of the 
diaphoretic, and for its soothing influence upon the inflamed 
part, we would use the warm bath, or the vapor bath, and 
continue it for an hour or two. I have obtained the most 
marked benefit from the warm bath, as hot as the patient 
could bear it, continued for four or five hours. If there is 
much derangement of the digestive organs give an emetic 
and follow with the Podophyllin Pill. If there are any symp- 
toms of rheumatism, the Tincture of Macro tys, with one 
drachm of Iodide of Potassium, in the twenty-four hours, 
will be beneficial. 

If it is caused by secondary syphilis, I order, R, Podophyl- 
lin, gr.viij; Asclepin,gr. xx; Extract of Conium, 3ss; Extract 
of Hyoscyamus, 3j ; M.; and make thirty pills, of which one 
may be taken every three hours, until they operate freely, and 
repeated daily; associated with this I should give an infusion 
of Asclepias or other diaphoretic freely, use the warm or 
vapor bath, and a solution of Acetate of Potassa, to the 
extent of three drachms of the salt daily. To the part 
affected, I have never seen a better application than equal 



Osteitis- 381 

parts of the Extracts of Conium and Belladonna,, softened 
with Tincture of Aconite y so as to spread freely on leather; 
as the disease progresses the strength should he supported by 
the bitter tonics and Iron, a free use of stimulants, and rich 
animal broths, with such other food as the- patient can take. 
As a local application, the one above named will be found 
useful in many cases. A poultice or fomentation of a decoc- 
tion of Poppy-heads, or Hops, or the Polygonum or Stramo- 
nium, will sometimes answer a good purpose. At other times 
these seem to increase the pain, and we have to resort to cold 
applications. Leeches applied to the part sometimes give 
marked relief, as do cups to the parts- adjacent to that affected. 
In some cases the pain was so excessive that I found it advis- 
able to make a free incision through the membrane, though 
in those the bone was superficial. "When pus has formed, 
there is no necessity of waiting for it to point, in fact, in a 
majority of cases it would be bad practice to do so, an incision 
should be carried down to the part affected, when frequently 
with the escape of a small portion of pus, the pain is greatly 
mitigated. If after this the inflammation continues, it will 
have to be treated as for disease of the bone. 



OSTEITIS. 

Inflammation of the bone occurs most frequently in early 
life, as at that time the osseous tissue is very vascular, whilst 
at a later period the vessels become smaller, and many of 
them disappear. It most frequently attacks the spongy 
tissue, though sometimes the more compact, in the first case 
resulting in ulceration, in the second frequently causing 
necrosis. It may result from injury, or from cold, and is 
most frequently met with in persons of a syphilitic, strumous, 
or rheumatic constitution. It may be acute or chronic. 

Symptoms. — The symptoms bear a very close resemblance 
to periostitis, which increasing for two or three or more 
days, becomes an intense boring or tearing pain, most exquis- 
ite and agonizing in its character, Very soon the superim- 
posed structures are involved, becoming hard, swollen, and of 
a tense shining appearance, with a slight reddish blush, and 
sometimes pitting on pressure. The pain is increased by a 
sudden movement or jar, or by the slightest pressure on the 



382 The Eclectic Practice of Medicine, 

part. This pain continues without intermission, being greatly 
increased at night, and by sudden changes of temperature; 
the soft parts become more and more involved, and at last 
suppurate, the event being announced by throbbing pain, and 
the accession of rigors. The constitutional symptoms are 
usually severe, the disease being ushered in by a chill or 
rigor, which is followed by high fever, and an arrest of the 
secretions. 

The acute disease will usually run its course in from one to 
three weeks, giving rise to serious structural changes, as soft- 
ening, caries and necrosis, unless resolution is effected by early 
treatment. When it terminates as above named, it is extremely 
tedious, and involves frequently the performance of important 
operations for the removal of the diseased structure, and in 
some cases the removal of the part. 

In chronic osteitis, the disease comes on slowty, and is not 
attended by the same constitutional disturbance. The pain 
is deep seated and circumscribed, and of an aching or tearing 
character. It is usually worse at night and during sudden 
changes of temperature ; if the inflammation is deep seated 
in the bone, as next the medullary canal, or the center of the 
cancellous structure of the extremities of long bones, there 
may be but little evidence of disease externally, except a very 
slight puffiness, and the peculiar shining appearance of the 
skin. In other cases, where the inflammation is superficial, 
the soft parts upon it become swollen, or at least participate 
in the disease to the extent of suppuration. As the disease 
progresses, more or less derangement of the general health 
obtains, — the appetite becomes impaired, there is loss of flesh 
and strength, the bowels are irregular, the skin harsh and dry, 
and the patient has a peculiar cachectic appearance. In its 
later stages, there are occasionally marked hectic fever and 
night sweats. 

Diagnosis. — As before remarked it is impossible to deter- 
mine between osteitis and periostitis, but as the treatment is 
similar, there is no special necessity for making the distinc- 
tion. Chronic osteitis may usually be known by the deep 
seated and tensive pain, enlargement of the bone, and peculiar 
tense glistening appearance of the skin. 

Prognosis. — Though rarely fatal, the disease does not usually 
terminate as favorably as we could desire. Going on to sup- 
puration we find more or less of the bone destroyed, and as it 



Osteitis. 383 

takes so long a period for the debris of devitalized bone to be 
removed, festulous pipes are formed through the soft structure 
to the seat of the disease; through them pus with bony debris 
is constantly discharged, keeping up a continuous irritation 
not only of the soft tissues, but of the bone itself. Escaping 
with difficulty, the material may by its simple presence give 
rise to an irritation that will keep up caries; or, from the 
change in the adjacent structure, ulceration of the bone may 
go on ; or, parts of the bone may have their vitality destroyed 
and separating from it, forming sequestra, which will continue 
the irritation and discharge by their simple presence. These 
further changes properly fall in the province of surgery, and 
need not be described here. 

Treatment. — In no respect will the treatment in cases of 
acute osteitis differ from that of periostitis. It must, however, 
be prompt, to be successful. I am a strong believer in the 
efficiency of the warm bath, or vapor bath, and diaphoretics, 
and the Podophyllin, as in the formula given under the head 
of periostitis. If these means are persistently applied, I am 
satisfied that in a considerable proportion of cases, resolution, 
may be effected. If the disease continues there is but one 
mode of relieving the intense suffering, and that is, to make a 
free incision down to the diseased part. 

In chronic osteitis we rely principally on alteratives and 
tonics internally, and counter-irritation to or as near as possi- 
ble to the seat of the disease. The Compound Tincture of 
Corydalis, with Iodide of Potassium, or Compound Syrup of 
Stillinona with the same, are very efficient. Usine; the last, I 
would recommend the Podophyllin Pill last named, to the extent 
of producing one or two free evacuations from the bowels 
daily. Associated with these, it is well to use a gentle bitter 
tonic, as the Hydrastis, Cornus, etc., and in some cases combine 
it with a proportion of wine. If the patient is feeble, a reason- 
able amount of stimulus may be ordered, ale or porter being 
the best. Special attention should be paid to the skin, the 
warm bath being used once or twice a week, and the salt water 
sponge bath with brisk friction daily. The diet should be 
nutritious, and to a considerable extent of animal food. 

Of local applications, we may use the irritating plaster, or 
painting with Iodine, or the Belladonna and Conium plaster 
mentioned on a preceding page. Each of these measures gives 
relief in some cases, but fails in others. Emollient poultices 



384 The Eclectic Practice of Medicine. 

are sometimes useful, as a decoction of Stramonium, Cornus, 
or Couium, thickened with "Wheat-bran, or the simple poul- 
tices of Elm, Flaxseed, etc. Sometimes counter-irritation near 
the affected part, when it is small and superficial, answers a 
good purpose. If these means fail, an incision should be 
carried down to the diseased part, and if deep seated 
within the bone; it maybe carried to the seat of purulent 
deposit by the small trephine. 



STRUMOUS DISEASE OE THE BQKES. . 

Tuberculous disease of the bones is not of very unfrequent 
occurrence, ranking about fourth in the scale of frequency of 
parts affected. The most common seat of the deposit is the 
cancellous or spongy portions of bone, being of most frequent 
occurrence in the vertebra, the short bones of the foot and 
hand, and the articular extremities of long bones. It occurs 
only in persons of a scrofulous or tubercular diathesis, marked 
evidence of feeble vitality being manifest before disease of the 
bones commences. The deposit is the result of irritation, 
sometimes from cold or disease of adjacent parts, at others from 
injury, and it may occur as circumscribed tubercle or as 
scrofulous infiltration. 

Symptoms. — Strumous disease of bones is almost always 
chronic, and the symptoms vary according to the scat or 
extent of the deposit. The patient usually contains of a dull, 
deep seated pain or aching, increased by sudden movement, or 
anything that causes a strain on the part. It is sometimes but 
little felt in the daytime when the weather is fine, but is w r orse 
at night and when the weather is changeable. If the disease 
is located in the back, the patient will complain of the back 
ache, and will relieve the part as much as possible by position. 
If of other parts slight enlargement will be noticed, and the 
pain is circumscribed ; there will also be, to some extent, that 
peculiar white glistening appearance of the skin which is so 
prominent a feature in the next stage. Sooner or later, the 
material will commence to break down, and determination of 
blood, and a low form of inflammation will be set up. ]S~ow 
the external tissues, in the case of the bones of the extremi- 
ties, become swollen and hard, the pain increases and becomes 
tensive, tearing or pulsating. The bone seems to be much 



Strumous Disease of the Bones. 385 

much enlarged, and the pain is increased by movement or 
direct pressure upon it. The part has a peculiar, blanched, 
smooth and glistening appearance that is peculiar to this dis- 
ease and strumous disease of the joints. Finally, suppuration 
results, the pus working its way to the surface being discharged 
through one or more openings. It is not generally laudable 
pus, but a watery material, with more or less bony debris, and 
small flocculi of coagulable lymph or tubercular deposit. From 
this forward, we have a case of caries, ulceration of the bone, 
or necrosis. If disease of the bodies of the vertebra has pro- 
gressed thus far, it may result in the formation of abscess, as 
in the case of psoas abscess from disease of the upper lumbar 
or lower dorsal vertebra ; or if, as is sometimes the case, the 
material is re-absorbed, curvature of the spine, from loss of sub- 
stance of the bodies of the vertebra takes place, with some- 
times paralysis from pressure thus induced, or from disease 
of the spinal cord set up by disease of the vertebra. 

Diagnosis. — In nearly all cases of strumous disease of the 
bones, there will be evidence of this diathesis so plainly 
marked that it will not be easily misunderstood. Then the 
slow progress of the disease, evidently confined to the bone, 
and presenting none of the symptoms of malignant disease 
or of exostosis, and the blanched glistening appearance of the 
surface, is usually sufficient. 

Prognosis. — In some cases, tubercles are deposited in bones, 
and in the course of time are partially absorbed, or so changed 
as to render them innocuous. Most generally they run the 
course laid down, the symptoms being more or less severe 
according to the part affected. In some cases it is hardly 
possible for the patient to live through the prolonged suffer- 
ing and loss of rest, and the exhausting discharge; but in 
others they pass through it with little difficulty. It almost 
always results in more or less deformity, and very frequently 
demands operative interference. 

Post-Mortem Examination, — In cases of death from this dis- 
ease, the bones affected are usually severely diseased. They will 
be found enlarged, softened, and more or less infiltrated, though 
the external shell may be somewhat compact. One or more 
fistulous openings or cloaca pass through this to an internal 
cavity, which is ragged, and contains more or less bony and 
strumous debris. Sometimes a great part of the structure of 
the bone is removed, nothing but a simple shell being left. 
25 



386 The Eclectic Practice oe Medicine. 

Treatment. — In the treatment of this affection, our first 
endeavor is to so improve the general health as to stop the 
deposit of this material or the progress of strumous osteitis. 
This is a work of difficulty, but is yet feasible in many cases. 
I usually put my patients on the use of small doses of the 
saline diuretics, as the Acetate and Citrate of Potassa, with 
an alterative and tonic combined, as #, Podophyllin, gr. x; 
Extract of Coninm, 3ss; Extract of Nux Vomica, gr. iij; 
Hydrastin, Quinia, aa, 3j ; M., and make three-grain pills, of 
which one may be taken every three or four hours or two 
three times a day. I give the above simply as an example of 
a combination of remedies that will set the digestive appa- 
ratus actively at work, and while promoting excretion, will 
cause better digestion and assimilation. Usually some pre- 
paration of Iron is- necessary, and I have found none better 
than the Carbonate in Catawba Wine. The surface should 
be bathed every second day with salt water, and the body 
dried with a coarse towel, brisk friction being used to bring a 
glow to the surface. A nutritious diet, consisting largely of 
animal food, and fatty matters, should be allowed, and plenty 
of exercise in the open air enjoined if it can be taken with- 
out inducing local innanimatiou. Usually the part will have 
to be kept so quiet, that if the patient is placed by the window 
where the sunlight can play freely, or carried out in the open 
air, it will be as much as can be done. 

As regards the local treatment, we may employ any of the 
means heretofore named that may seem applicable to the case. 
The irritating plaster is sometimes of imminent service, as in 
cases of disease of the vertebra; frequently it is not necessary 
to carry it to suppuration, but in severe cases its greatest 
influence will not be obtained short of that. A very valuable 
application is formed of equal parts of powdered Podophyllin 
and Thuga Occidentalis, or Arbor- Vitas, made into a poultice 
with warm Milk; it may be used at any point. The most 
essential part of the treatment is obtaining perfect rest of the 
part affected, and this can only be done in many cases by the 
use of splints and other surgical appliances. 



DISEASES OF THE JOINTS. 

I propose to give under this head a short sketch of the 
prominent diseases of the articulations, with the medical 



Acute Synovitis. 387 

treatment necessary, referring to the more extensive works 
on surgery for their full description. I deem this necessary, 
as the practitioner is constantly meeting with such cases, and 
frequently has not at command works that give the desired 
information. We have already seen that rheumatism may 
give rise to very serious affections of the articulations, espe- 
cially the chronic form of the disease; and we will find in 
practice that it is sometimes difficult to make the diagnosis 
between joint disease from rheumatism and from other causes. 
"We have to notice but one acute disease, synovitis, and will 
group all the others together under the heading of chronic dis- 
ease of the joints. 



ACUTE SYNOVITIS. 

Acute inflammation of the synovial membrane of a joint is 
serious in proportion to its size, in the larger articulations as 
the knee, ankle, wrist and elbow, giving rise to very serious 
constitutional disturbance. It usually has its origin from an 
injury, especially from a penetrating wound of the joint; but 
is sometimes the result of cold, or of cold following a slight 
injury. 

Symptoms. — Usually the first evidence of the disease is a 
feeling of stiffness and soreness of the joint, with tearing pain 
when it is suddenly moved or twisted. In the course of one 
or two days a violent inflammation is lit up, generally ushered 
in by a marked chill or rigor, which is followed by febrile 
reaction. The fever at first is usually high, the pulse fre- 
quent and hard, the skin hot and dry, the tongue coated 
white, the appetite gone, bowels constipated, urine scanty 
and high-col oreel, pain in the head and baok, and great irrita- 
bility and restlessness. Occasionally the local inflammation 
is very acute, with comparatively little constitutional disturb- 
ance. Usually the more acute constitutional symptoms 
subside in three or four days, the fever becoming remittent in 
character, or replaced by hectic fever in the latter stages. 

With the commencement of the inflammation the joint 
swells rapidly, and in the course of two or three days becomes 
distended to a greater extent than would be deemed possible. 
It is usually very red and hot, the heat and redness extending 
for some distance above and below the articulation. The pain 
is intense during its entire progress, tensive, throbbing, tear- 



388 The Eclectic Practice of Medicine. 

ing and lancinating, and at times so severe that the patient 
cries out with agony. The part is usually exquisitely tender, 
the slightest pressure or motion greatly aggravating the suf- 
fering. If permitted we readily determine that the swelling 
is consequent upon the distension of the synovial membrane. 

The disease continuing, effusion of plastic lymph occurs 
within the synovial membrane, which sometimes becomes 
organized, forming adhesions, but more frequently breaks 
down, forming flocculi in the synovia, or is changed into pus ; 
or the synovial membrane becomes thickened and rough, 
secreting a viscid synovia, or semi-purulent material. In 
some cases the disease extends to the articular cartilages, 
which become softened and eroded, so as to expose the bone, 
giving rise to osteitis, and all the results that follow it. These 
diseased conditions most usually follow injuries of the joints, 
but may sometimes result from the inflammation produced by 
cold. The symptoms are such as might be expected from the 
nature of the lesion. If the joint is large, as of the knee, 
ankle, elbow or wrist, there is great prostration with hectic 
fever, night sweats, and their attendant symptoms. It will 
sometimes run its course rapidly, two, three or four weeks 
being sufficient to cause the grave changes named, in other 
cases it will require as many months. 

Diagnosis. — In superficial joints the character of the disease 
may be determined by its sudden accession and the marked 
heat, redness and swelling, and severe tensive and twisting 
pain. In the hip and shoulder joints, it is not so easy to 
determine distension of the synovial membrane, yet careful 
examination in the one case, by the side of the trochanter 
major and below Poupart's ligament, and the other in the 
inside, and each side of the deltoid, will likely determine 
synovial fluctuation. The more advanced stages may be 
determined to a great extent by the symptoms already named. 

Prognosis. — In almost all cases except those resulting from 
injury, resolution may be effected without injury to the 
structures. When caused by injury, this result is more 
difficult to attain, but may be accomplished in a majority 
of cases. 

Post-Mortem Examination. — In the early stages of the 
disease the synovial membrane shows a slight reddish-blush, 
and the vessels passing to it are seen to be enlarged; there 
is a greatly increased secretion of synovia, sometimes nearly 



Acute Synovitis. 389 

natural, but more frequently yellowish and viscid. Progress- 
ing beyond this, almost every stage of destruction is noticed, 
the synovial membrane being thickened, or in some cases 
softened; more or less ilocculent material in the synovia, 
which is turbid and opaque, or in some cases purulent; the 
cartilages are eroded or destroyed, and the bone diseased to 
a greater or less extent. 

Treatment. — At the commencement, before acute inflam- 
mation has sprung up, there being the feeling of soreness 
and stiffness first mentioned, I should give the patient a brisk 
purgative of Compound Powder of Jalap and Senna, and Bi- 
tartrate of Potassa, following it with a diaphoretic of equal 
parts of Essl. Tincture of Asclepias and Tincture of Serpen- 
taria, in teaspoonful doses, or the Diaphoretic Powder in doses 
of ten grains in some warm infusion. With this, I should 
administer a full close of Opium at bed time, and repeat it 
sufficiently often to keep down irritation. Locally, the use of 
cups and scarification a short distance from the joints, and 
strapping with Belladonna plaster, or, if this can not be 
obtained, common Adhesive plaster will answer a better pur- 
pose than anything else. Perfect rest must be obtained, and 
if this can not be accomplished otherwise, a splint should be 
applied. It seems to me to be the greatest folly to permit a 
person to use an injured joint, even to the slightest extent, 
until after all danger of inflammation lias passed. 

If the inflammation is acute when called, we would use the 
cathartic as before, and to assist the action of the diaphoretic, 
use the warm or vapor bath thoroughly. In addition, a solu- 
tion of Acetate of Potassa will be found to assist in dispersing 
the inflammation. I have great faith in the action of Opium 
in these cases after secretion is established, giving it in doses 
of one or two grains sufficiently often to quiet the pain. It 
is most markedly antiphlogistic in its action, and at the same 
time gives ease when otherwise the pain would be constant 
and intensely severe. By the second or third day, the secre- 
tions being free, we may employ Quinia in some cases with 
marked advantage. It seems to quiet irritation, favors a nor- 
mal circulation of the blood, and though in no respect narco- 
tic, yet it is second to Opium in giving the patient ease. 

Warm fomentations of bitter herbs or narcotics are most 
generally recommended as a local application, and though 
sometimes giving relief, I must confess that I do not like 



390 The Eclectic Practice of Medicine. 

them. Next in frequency, poultices of various kinds are 
used, but without any very marked benefit. The narcotics 
and sedatives, Belladonna, Stramonium, Opium, Aconite and 
Veratrum are useful remedies in many cases, quieting the 
local irritation, and assisting in the arrest of the inflammation. 
The stimulating and sedative liniments named under the head 
of sub-acute rheumatism, may also be used when the case 
progresses slowly. My plan of treatment now, is to have the 
joint thoroughly cupped, or if this is not convenient, leeched, 
at a short distance from the seat of inflammation; it should 
then be strapped with Belladonna plaster or common Adhe- 
sive" plaster, and placed upon a splint that will not permit 
the slightest amount of motion. This does not seem to the 
patient or young practitioner like doing enough, and yet it 
will prove far more satisfactory than the other measures 
referred to. Time is required to effect resolution, and it must 
not be expected that this or any other means will relieve the 
suffering in a few hours. If the disease goes on to produce 
the serious structural changes named, it will have to be treated 
as the succeeding affections. 

In some cases it will be found that the disease is not in the 
slightest degree mitigated by this or any other treatment; the 
swelling increases until it seems impossible for the joint to 
become larger, and the pain becomes so excruciating as to be 
unendurable, and the patient will pray for any relief, even 
death itself. "We can see from all the symptoms that rapid 
destruction of the joint is going on, and that if relief is not 
soon afforded the destruction will be so great as to be irre- 
parable, even should the patient survive. What shall we do 
in these cases? Authorities seem to differ, but I should incise 
the joint, and keep it open, until the inflammation was sub- 
dued. It is good treatment in disease of the smaller articula- 
tions, and I have been forced to adopt it in two cases of dis- 
ease of the knee joint, very much against my will, but with 
the best of success in both instances. Dr. Cooper, of San 
Francisco, clearly proved that opening into joints was attended 
with but little danger, yet the old prejudices prevent the gen- 
eral adoption of his practice. 



Chronic Disease of Joints. 391 



CHROMIC DISEASE OF JOINTS. 

Chronic articular disease is always inflammatory at some 
stage, and very frequently is so at the commencement. Each 
of the tissues entering into its formation may be affected, but 
it usually commences in the synovial membrane, or in the 
articular extremities of the bones. The causes are various ; 
thus, it may arise from an acute inflammation, from rheum- 
atism, from injury, from the common causes of inflammation 
elsewhere, or from strumous deposit in some of the tissues 
entering into the formation of the articulation, or adjacent 
to it. Essentially chronic in its character, it sometimes comes 
on insidiously, and always runs its course slowly. 

Symptoms. — The general symptoms of chronic articular dis- 
ease are: a gradual enlargement of the joint, with more or 
less pain, usually of a dull, aching character, but becoming 
more intense as the disease progresses. A feebleness of the 
muscles moving the part, and of the joint itself. Displace- 
ment of the bones to a greater or less extent, and deformity 
in consequence. In many cases the joint presents a blanched, 
glistening appearance, though it may be hot, and very pain- 
ful ; hence, the common term, white swelling, applied to this 
class of diseases. The constitutional symptoms are always 
very marked. As the disease advances we find the patient 
becoming cachectic; the appetite is poor; bowels irregular; the 
skin and kidneys fail to perform their functions properly, and 
there is marked derangement of innervation. Sometimes the 
effect of the local disease is so severe in the case of the larger 
articulations, that the patient is soon confined to his bed, from 
which frequently he does not get up for weeks and months. 
During this time very many changes take place in the dis- 
ease ; at times severe fever, so that it would seem impossible 
for the patient to live; again, marked irritation of the ner- 
vous system, the patient being extremely irritable and sensi- 
tive, and can not be moved without the greatest suffering, and 
resting badly at night; occasionally almost complete loss of 
appetite, or very feeble digestive power, being troubled with 
flatulence, acidity, "etc. ; or hectic fever of a most persistent 
character, with night sweats, makes its appearance, with 
sometimes tendency to colliquative diarrhoea. Altogether, in 
cases of disease of the larger articulations, there is a success- 
ion of the most adverse symptoms; one appearing when 



392 The Eclectic Practice of Medicine. 

another is removed, that renders its treatment anything but 
pleasant. 

Hydrarthrosis is the most simple of these articular diseases. 
It occurs most frequently in the young, and is very rare after 
thirty. It is usually preceded by an injury, an acnte inflamma- 
tion, or rheumatism, from which the part seemingly recovered 
at the time. Sometime afterwards it is noticed that the joint 
is becoming enlarged, is weak, though still used, and is some- 
times the seat of a dull, obscure pain. The distension is 
sometimes not very great, but at others the articulation is ren- 
dered a shapeless mass from the very great accumulation of 
synovia, which distends the joint most in the direction of the 
least resistance. As it continues, the areolar tissues become 
thickened at the parts where there is the greatest pressure. 
The only change observed after death is the thickening of the 
synovial membrane, with sometimes softening, and marked 
enlargement of the fringes of the alar ligaments, sometimes 
to such an extent that they seem to be fleshy masses. 

Strumous Synovitis is diagnosed, according to Mr. Barwell, 
by the following symptoms. " The swelling is either before 
pain, or is discovered with the pain. Pain being a later symp- 
tom as regards visible swelling ; yet when it comes on it is 
constant. The bones forming the articulation are blended by 
the swelling into one rounded shapeless mass, which overlies 
both parts of the joint equally, and conceals greatly or alto- 
gether the line of junction between the two bones. There is 
no preference of place ; the swelling is equable over the whole 
joint. The integuments are not at all, or scarcely increased 
in temperature." 

In Strumous Articular Osteitis, "the first symptom is heavy 
dull pain with limping or other imperfection in the use of the 
limb ; this comes on before any swelling is perceptible. The pain 
is generally increased in bed, and is subject to variations ; some- 
times quite disappearing for a time, and again returning. The 
swelling at first is confined to one portion of the joint; for 
instance, at the knee, the upper where the femur, the lower 
where the tibia is affected. Afterward, though the whole 
joint be enlarged, the tumefaction is more marked, harder and 
larger over the bone primarily affected, and is nearly always 
on one side of the joint. The division between the bones 
remains evident to the touch. In all but the deepest placed 
bones, the integuments over them are sensibly hotter." 



Chronic Disease of Joints. 393 

The same author lays down the following well-marked 
symptoms of caries and necrosis: "In the first, during the for- 
mation of pus, the general and local symptoms increase in 
intensity, and continue to increase even after an external open- 
ing has been made. The sinuses are crowned with florid 
granulations which bleed extremely easily. They are sur- 
rounded by thin, blue, contracted skin. The pus is plentiful, 
thin and irritating. A probe finds the diseased bone surface 
with difficulty, on account of the windings of the sinus. The 
surface is rough, slightly yielding, and brittle, though parts 
give way, it gives an idea of softness. In necrosis, where pus 
forms in the soft parts, and more particularly when it has 
been let out, the symptoms diminish. The sinuses are crowned 
by florid, but not brilliant granulations, which do not bleed 
with extreme ease. They are surrounded by normal or slightly 
altered skin. The pus is not large in quantity, and is in 
general nearly laudable. A probe passed along a sinus to 
necrotic bone finds the passage tolerably straight or simple. 
The bone is hard, brittle, sometimes moveable. Often one 
may feel the probe pass through a sinuous opening (cloaca) in 
bone before it comes to the dead portion." 

Diagnosis. — The diagnosis of chronic articular disease is 
usually easy, when the joint is superficial; but difficult when 
deep seated, as in case of the hip and shoulder joints. The 
main features of the affection and the symptoms distinguishing 
different lesions have already been noticed. 

Prognosis. — When the synovial membrane is alone affected 
the prognosis is much more favorable than when the disease 
commences in the bone. If but little change has taken place 
in the structures, we may hope to arrest the disease and save 
the joint. In other cases we may sometimes get a useful limb, 
but frequently with deformity and stiffness, or anchylosis of the 
joint. These cases are usually tedious, and call for very great 
care, and the judicious application of remedies to meet the 
symptoms as they arise. 

Post-Mortem Examination. — Dissection reveals various 
structural lesions, corresponding to the symptoms during life. 
If the synovial membrane was alone affected, it is usually thick- 
ened, more or less rough, and in some cases changed to a pus- 
secreting structure ; the synovia increased in quantity, may be 
nearly normal, or viscid, or containing flocculi and shreds of 
lymph, or semi-purulent, or in some cases thick and grumous. 



394 The Eclectic Practice of Medicine. 

Passing beyond this, we find the cartilages eroded or entirely 
destroyed, and more or less extensive caries of trie bone. In 
articular osteitis, the bone is enlarged and carious or necrosed, 
with fistulous pipes passing to the surface ; in some cases a 
considerable portion of it is broken down, the site being filled 
with bony debris and ill-looking pus. 

Treatment. — When called to treat a case of chronic articu- 
lar disease, our first object is to so arrange the part as to 
obtain most perfect rest. If of the lower extremities it will 
be necessary to confine the patient to the bed for a period of 
weeks, or in some cases from four to six months. In addition 
to this a splint should be carefully adapted to the part, so as 
to render it entirely immovable, and at the same time make 
sufficient extension to prevent pressure of the bones from 
contraction of the muscles. Though joint disease may be 
cured without these measures, yet it is tedious, and the suffer- 
ing is frequently intense; and in many cases from want of 
attention to this point the joint is lost, or the disease termin- 
ates fatally. 

If the patient is strong, and there seems to be irritation of 
and determination to the joint, we may resort to an antiphlo- 
gistic treatment: as, from catharsis, the alkaline diuretics, 
the warm or vapor bath with diaphoretics, etc.; but, as a 
general rule, no advantage will result from it. If there is 
fever, we remove it b} r the use of the special sedatives and an 
alkaline diuretic, the bowels being kept moderately open ; and 
as soon as secretion is established, we may employ Opium to 
give the patient rest at night if the pain has been so severe as 
to prevent it. After this, we resort to the vegetable tonics 
and alteratives to keep up secretion and give tone to the 
digestive apparatus and entire system. I have obtained the 
best results from a combination of equal parts of Alnus, 
Rumex and Scrophularia in infusion, giving a wineglassful 
four times a day, with from five to ten grains of Iodide of 
Potassa at each dose, and the use of the Iodine and Nux 
Vomica Pill heretofore named ; or we may get an alterative 
and tonic combined, as in the formula of Nux Vomica, 
Hydrastin, Quinia and Podophyllin, under the head of chronic 
disease of the bones. "With this, if the patient has no febrile 
action, I order Ale or Porter, or in some cases Wine, or Eye 
Whisky and Cod-liver Oil. 

Recollect that it is not necessary to give large quantities of 



Chronic Disease of Joints. 395 

medicine, nor to give it where there is no necessity for it. I 
have treated cases of articular disease in which for two 
months the patient had nothing but the last named pill to 
the extent of moving his bowels once or twice daily, and as 
much Ale as he desired to drink, and yet he was confined to 
his bed. I have obtained marked advantage from the nse of, 
#, Essl. Tincture of Asclepias, 3j ; Hydrochlorate of Ammo- 
nia, 3j ; Simple Syrup, 3iij ; M., and give in teaspoonful doses 
every three hours. It keeps the skin soft and pliable, urinary 
secretion free, and quiets marry of the disagreeable nervous 
symptoms that are so common. If the pain is very severe 
and can not be controlled by local applications, we may nse 
Opium or its preparations, but would prefer to get along 
without them, except as occasional remedies ; the other nar- 
cotics, Hyoscyamus, Verbascum, Belladonna and Conium, 
may be occasionally used, but will not be found to be gener- 
ally advantageous. If the pain is severe in the afternoon 
and evening, especially if attended with hectic fever, we 
may relieve it by the administration of Quinia, Prunine or 
the Essl. Tincture of Euonymus. If there is a loaded tongue 
or foul stomach, I would use an emetic, getting its thorough 
action, and following with equal parts of Oxide of Zinc and 
Hydrastin, two grains four times a day, in pill or powder, and 
a solution of Acetate of Potassa. I have seen a severe hectic 
fever and night sweats arrested in this way when all other 
means had failed, and the patient regain his appetite and 
commence to recover, the first evidence of amendment dating 
from the emetic. 

As regards local applications, it is sometimes desirable to 
use none at all, keeping the part perfectly quiet and undis- 
turbed. In other cases the application of a plaster of May- 
er's Ointment, made strictly according to the Dispensatory, 
will be found highly useful; or take equal parts of Rumex 
and Phytolacca, simmer them in Lard, express, and to each 
ounce, add one drachm of Venice Turpentine, and half a 
drachm of pulverized Camphor. These applications are 
the best I have ever used in cases where the disease was 
progressing slowly, and the part was not very painful. If 
painful, I use the Belladonna plaster, or other narcotic appli- 
cations. When the part is tender and painful, as is frequently 
the case when we are first called, we may poultice it with a 
decoction of Cornus or Stramonium, thickened with Wheat- 



396 The Eclectic Practice of Medicine. 

bran, and when the irritation has subsided, resort to the other 
applications named. 

In hydrarthrosis or strumous synovitis, next to perfect rest 
we obtain the greatest advantage from straps. I am accus- 
tomed to use any medicated plaster that I think indicated for 
this purpose, as almost all of them are sufficiently adhesive 
for our use. I have employed the irritating plaster for this 
purpose, spreading it on strips of muslin an inch wide, warm- 
ing and applying so as to make a continuous and even 
compression. The common strengthening plaster answers 
well ; and Mayer's Ointment, made according to the formula, 
with Gum Turpentine is excellent. If these are not obtain- 
able, use the common adhesive ^straps, applying as firmly as 
the patient can bear without increasing the pain. 

In hydrarthrosis it is proposed by sub-cutaneous incision 
to let the fluid escape into the areolar tissues, from which it 
will be absorbed, which is doubtless good practice. In other 
cases, the majority have decided that it is not proper to open 
the joints in any case, but the minority have shown* in 
numerous instances that itls not only feasible and unattended 
with danger, but is often the only mode of procedure that 
will save the structure of the joint. This is entirely a surgi- 
cal question ; and for its solution, as well as the further 
surgical treat ment, the reader is referred to the surgical 
works of the day. Barwell, Dr. Bauer, and Dr. Lewis Sayre, 
being the authorities that I should prefer to follow. 



Diseases of the Nervous System. 397 



CHAPTER VII. 

DISEASES OE THE NERVOUS SYSTEM. 

In addition to the important part occupied in all diseases 
by derangements of innervation, we find that the nervous sys- 
tem is subject to many diseases, some of which are among the 
most severe that the system is liable to, and others are 
especially intractable to medicine. We have to recognize 
three distinct sources of nervous supply: the brain, the spinal 
cord, and sympathetic ganglia, each of which has a special 
purpose to subserve, and is more or less independent of the 
other. The brain is the organ of the mind, and furnishes the 
force by which a very large portion of the body is brought 
under the influence of the will. We may consider it as 
entirely the organ of volition, as in many of the lower species 
it does not exist at all, and even in some of the vertebrata is 
rudimental, and in none does it correspond with the need of 
innervation. The expansion of the cerebrum is especially the 
organ of thought, and rather detracts from than adds to the 
vitality of the person. The basilar portions of the brain may 
be considered as expansive to some extent of the spinal cord, 
and are eminently vital parts ; the tenacity of life and power 
of living depending to a very considerable extent upon its 
development and perfect condition. While so serious a lesion 
as the removal of a considerable portion of the front lobes of 
the brain may be recovered from, the slightest injury of the 
sensory ganglia or medulla oblongata will cause death. 

Within the spinal cord we find gray nervous matter, giving 
origin to nerve fibers, though surrounded by the white fibers 
of communication of the brain. This is the center of the 
reflex or excito-motory nervous force, one that plays a very 
important part in the living body. It carries on certain func- 
tions when the will is in abeyance, and others that are left but 
partially under the influence of the will. Thus the respira- 
tory function is carried on by this system of nerves, as is also 
deglutition, and all of the involuntary movements. It is sup- 
posed that nerves from this source pass to every part of the 



398 The Eclectic Practice of Medicine. 

system, and exercise a very considerable controlling influence. 
We will find hereafter that they may take entire command of 
the body, the brain no longer having any or but slight control. 

The sympathetic nervous system seems to preside over the 
functions of vegetative life, and though both ganglia and 
nerve fibers are very minute, they govern the most important 
of all functions in the body — those of digestion, assimilation, 
nutrition, secretion, and the circulation of the blood. Though 
so minute in structure, yet it is probable that there is not a 
space the size of a pin's head in the entire body that has not 
its sympathetic fibril. Wherever a blood-vessel goes, there 
goes a sympathetic nerve, to watch over the vital fluid, and 
see that it is properly applied. 

These three parts are very intimately connected, the sympa- 
thetic ganglia with the spinal cord immediately posterior to 
them, and the spinal cord directly with the brain through 
fibers of communication. This connection is not marked dur- 
ing health, and is only developed to any considerable extent 
during disease. These symptoms have already been noticed, 
and will hereafter be seen to play a very important part in 
some affections. 



PTIREMTIS. 

The brain and its membranes occupying the cavity of the 
cranium is subject to inflammation like all other structures. 
The disease may attack and be confined to the membranes of 
the brain, cerebral meningitis, or it may affect the substance 
of the brain itself, cerebritis; but very generally affects both 
to some extent. As it is impossible to decide during life 
whether the membranes or the substance of the brain is the 
seat of the disease, there is little use in trying to draw a dis- 
tinction between the two. Phrenitis may be caused by cold, 
and other causes tending to produce irritation of the 
brain, the state of the blood, and by injuries. It is almost 
always acute; in fact, I doubt if we are able to recognize a 
chronic inflammation of this organ, unless it may be of the 
meninges, producing chronic hydrocephalus. 

Symptoms. — The invasion of the disease is indicated by a 
sense of fullness and pain in the head, the integuments being 
suffused, and sometimes a marked sense of heat. Frequently 
the patient complains of dullness, with confusion of ideas and 



Phreketis. 399 

forgetfulness, and unquiet sleep. Extreme irritability and 
fretfulness, with indisposition to sleep, and frequent startings 
during rest, the cry being sharp and quick, as if terrified, are 
the precursory symptoms in children. The disease is usually 
ushered in with a marked rigor or chill, continuing for an 
hour or two, or sometimes for nearly a day. Following this, 
there is in most cases high febrile reaction, the skin is hot and 
flushed, the pulse frequent and hard, tongue coated white, 
bowels constipated, and urine scanty and high-colored. The 
head is turgid and hot, the eyes more prominent and suffused, 
the pupils contracted and fixed, and a deep seated, heavy, pul- 
sating and tensive pain in the head. 

As the disease progresses, the patient becomes more irrita- 
ble and restless, the pain in the head increases, there is intol- 
erance of light, ringing in the ears and intolerance of sound, 
sleeplessness and delirium. Up to the third or fourth day the 
fever is usually continuous, though sometimes there is a slight 
remission in the forenoon, and the head symptoms increase 
or continue without abatement. A marked change is now 
observed, the acute sensibility gives way to torpor, and the 
delirium becomes low and muttering, or is replaced by coma. 
The pulse becomes fuller, softer or slow, or in some cases very 
hard and frequent. The head and trunk is still hot, the face 
turgid and of a deeper color, or in some cases blanched and 
contracted, the pupils dilated, the extremities cool, respiration 
difficult and sometimes stertorous, and more or less involun- 
tary movement and starting of the tendons. The coma grad- 
ually becomes deeper,and the insensibility more marked; all 
the functions are feebly performed, the patient lies on his 
back, slips down to the foot of the bed, grasps at imaginary 
objects, and thus slowly sinks. According to Copland: "In 
some cases, particularly those in which the cerebral substance 
is early and generally inflamed and turgid, instead of phre- 
nitic delirium, an apoplectic sopor, often preceded by convul- 
sions, quickly supervenes; with a slow pulse, stertorous, slow 
or labored breathing, turgid or bloated countenance, startings 
of the tendons, involuntary evacuations, torpor of the senses, 
and flaccidity of the limbs." Here the first stage is very 
short, or not noticed, and the disease passes rapidly to a fatal 
termination. 

In children we frequently find inflammation of the brain 
• making its appearance during the progress of other diseases. 






400 The Eclectic Practice of Medicine. 

The head becomes hot, the face turgid, the pupils contracted, 
with great restlessness and constant movement of the head. 
Though not very marked on account of age, the child is evi- 
dently delirious, and the frequent movement of the head, and 
putting the hands up to it, shows that it suffers pain. In 
other cases the acute stage has passed without notice, the face 
is blanched and contracted, or white and puffy, the pulse is 
small and very frequent, the extremities cool, bowels loose, 
the operations being unnatural and offensive, there is contin- 
ued movement of the head and restlessness, or a deep stupor 
or coma. Sometimes the symptoms will continue for three 
or four days, but at other times the disease will terminate 
fatally within forty-eight hours. 

Diagnosis. — It is not difficult in the most of cases to deter- 
mine the presence of phrenitis. The heat and turgidity of 
the face and scalp, the deep seated and tensive pain, contract- 
ed pupils, and tlie great irritability and restlessness, with the 
high grade of fever, are sufficient for the diagnosis. In tho^e 
other cases in which coma, difficult respiration, full, but 
oppressed pulse, coldness of the extremities, dilated pupils, 
etc., are the attendant symptoms, the diagnosis will be very 
difficult, and if we cannot have the previous history of the 
case, almost impossible. 

Prognosis. — In the first stage of the disease, the prognosis 
is usually favorable if prompt measures are adopted for the 
arrest of the inflammation. In the second stage the lesions are 
so great that we will have to be guarded in our prognosis, 
though a considerable number will recover. 

Post-Mortem Examination. — The membranes of the brain 
will be found to have been involved most frequently. The 
dura-mater may be injected, as may also the arachnoid in 
some places; there is sometimes increased quantity of fluid, 
but little changed or viscid, or containing flocculi of coagula- 
ble lymph, in rare cases adhesions having formed between the 
free surfaces. The vessels of the pia-mater may be distended, 
and on making an incision into the brain, if involved, it is 
found to present a more uniform red color than natural, and 
the puncta vasculosa more numerous and larger. 

Treatment. — In the stage of active determination in the 
adult, we would commence the treatment by the administra- 
tion of a brisk cathartic, as Compound Powder of Jalap and 
Senna and Bi- tartrate of Potassa, in doses of one drachm of 



Phrenitis. 401 

each in a reasonable time if it should not act. In mild cases, 
the hot Mustard foot bath may be thoroughly used, but in 
the more severe I prefer the warm bath, and the vapor bath 
in addition. With these we would use a diaphoretic, as an 
infusion of Eupatorium, Salvia, etc., or of the Essl. Tincture 
of Asclepias, Serpentaria, Eupatorium, or similar remedies. 
To prevent determination to ' the head I use Gelseminum, 
giving it in doses of from twenty to forty drops of the Tincture 
every two or three hours until its full influence upon the sys- 
tem is obtained. If there are specific remedies, I should 
name this as one, its effects being most marked in these cases. 
Great care should be used, however, in its employment when 
the stage of excitement is passing into that of prostration, as 
it may so paralyze the brain as to induce fatal congestion. 
In the second stage of the disease, with coma and dilatation 
of the pupils, it must not be used. 

In many cases, if we obtain the action of a cathartic, and 
use the hot foot bath or general bath, the diaphoretics named 
will induce sufficient sedation without other means. If, how- 
ever, the fever should run high, there being much heat of the 
head, I would associate with them the special sedatives, Tinc- 
tures of Yeratrum and Aconite, in doses of one drop of each, 
largely diluted with water, every hour. If the bowels are 
loose, as is sometimes the case, the general bath will have to 
be rendered stimulant in order to get the necessary amount of 
derivation, cathartics being contra-indicated. In some cases 
the stomach is irritable, and nausea and vomiting so constant 
as to prevent the administration of the proper remedies; here 
I should give a thorough emetic, and expect the best results 
from it. The emetic may also be used in cases where we 
have reason to suppose that the stomach is loaded with crude 
ingesta, or with vitiated secretions. As soon as the bowels are 
moved, and sometimes before, we might commence the use of 
the alkaline diuretics, largely diluted. 

In addition to the means of derivation already named, we 
find it advantageous to apply cups to the neck, and even to 
the entire length of the spine ; in some cases they should be 
thoroughly drawn and scarified. Some use a sinapism to the 
nape of the neck, but it is too feeble ; if it is thought prefer- 
able a blister may be used instead of the cups. Sometimes 
we find it advisable to use stimulants to the entire lower 
extremities, as flannel cloths wrung out of hot Mustard water. 
26 



402 The Eclectic Practice of Medicine. 

The head must be kept cool, either by the direct application of 
cold, or the use of evaporating lotions. I prefer warm water 
applied to the head with a sponge, and evaporation favored 
by fanning ; sometimes the water may be used quite warm if 
feeling grateful to the patient, and allaying much of the irri- 
tability. 

When the disease has passed into the second stage, our 
treatment will have to be changed, everything looking to 
depletion being discarded. A stimulant purgative, as Podo- 
phyllin with Capsicum and Extract of Hyoscyamus to the 
extent of producing one or two stools daily, is useful. Stimu- 
lant applications to the extremities are necessary, and counter- 
irritation may be applied the entire length of the spine. I 
use dry cups to the spine, followed by a sinapism, and wet 
cups to the nape of the neck. When using the cups and 
scarificator it is not our object to remove the blood, hence the 
cupping-glass is never applied after scarification. The warm 
water applications to the head may still be employed if there' 
is heat, or we may add a portion of Tincture of Camphor to 
the water employed to render it stimulating ; or in some cases 
a weak Tincture of Camphor may be used alone. It should 
always be borne in mind that there is as much danger in 
keeping the head too cool in this stage as in letting it remain 
too warm. Carbonate of Ammonia and Brandy are the only 
internal medicines that I find any use for, unless in some 
cases I give Quinia, though this usually comes in at a later 
stage. To an adult the dose would be from half to one table- 
spoonful every hour or two hours; to a child two years of age 
about one teaspoonful. The urinary secretion should be 
carefully watched, for if suppression of urine should occur, 
or even retention, our patient will live but a short time. If 
the secretion is deficient, equal parts of Sweet Spirits of Mtre 
and Essence of Juniper will prove useful, or a small quantity 
of Turpentine may be used with the Mtre. 

Convalescence from this stage of phrenitis must be care- 
fully watched. As soon as consciousness returns, we may 
commence the administration of Quinia, about six grains in 
the forenoon, to arrest the obscure remittent fever that is so 
generally attendant. If there are objections to continuing 
the Brandy, we will find the ISux Vomica and Hydrastin, as 
heretofore recommended, efficient substitutes. No continued 
mental exertion should be allowed, and excitement should be 



Acute Hydrocephalus. 403 

studiously avoided, in other respects the convalescence must be 
managed as in other severe diseases. 



ACUTE HYDKOCEPHALUS. 

We use this term, for the want of a better one, to distin- 
guish a certain class of cases in which the disease of the brain 
is a principal lesion, though the symptoms would indicate 
something else. The disease is confined almost entirely to 
children, occurring most frequently from the ages of one to 
three years, and being rare after the age of twelve. It is 
very difficult to determine the cause, though we are of the 
opinion that it is frequently dependent upon irritation of the 
digestive apparatus, or upon any cause that will enfeeble the 
system. At the ages of ten or twelve it is usually brought on 
by over mental exertion. 

Symptoms. — At an early age, we find the disease commen- 
cing as an obscure remittent fever, the languor, or more 
properly stupor, being the most prominent symptom. The 
fever usually has an exacerbation in the afternoon, the child 
beinsr restless and fretful at this time. Nausea and vomiting 
is very frequently present, especially if there is irritation of 
the bowels, forming one variety of cholera infantum. In a 
longer or shorter time, usually not more than from two to ten 
days, the patient becomes almost entirely unconscious, though 
from the occasional glance of intelligence it is not believed by 
the parents. Still it is restless and uneasy, turning its head 
from side to side, putting its hands to its head, and uttering 
those sharp, piercing cries indicative of pain; if the tongue 
can be seen, it will be found dry, its tip and edges red, and 
center covered with a white coat. The countenance is now 
pallid and pinched; the eyes want expression, and are sunk in 
the head, the pupils generally dilated ; the head is not above 
normal temperature, frequently dry, although the forehead is 
covered with a clammy perspiration. If there was not diar- 
rhoea at the commencement, there is now, the stools being of 
a dirty-yellowish or greenish color, mixed with slimy matter 
and having an offensive odor. 

A very common grouping of symptoms is thus reported in a 
clinical case by Dr. Bennet: " Unconsciousness of surrounding 
objects, not recognizing even her mother; pupils not con- 



404 The Eclectic Practice of Medicine. 

tractile to light ; slight strabismus of right eye ; frequently 
puts her hands to the head, which is rolled about uneasily ; 
continual grinding of the teeth, low moaning, and occasional 
muttering. Tip of tongue, which is all that can be seen, very 
dry and of a scarlet color; loss of appetite; constant thirst; 
vomiting; involuntary discharge of fseces and urine; on press- 
ing the abdomen uneasiness evidently experienced, and moan- 
ing increased; skin hot and dry; no eruption; a small abscess 
at the back of the neck, with a sanious discharge ; action of 
the heart feeble and fluttering; pulse 140, small, and occasion- 
ally intermittent. Breathing short and hurried ; no rales." 
These symptoms were developed in a child aged six, commen- 
cing fourteen days previously with diarrhoea. 

In older children the first symptoms will be a more or less 
severe headache, with intellectual stupor, the child being rest- 
less and uneasy, and passing bad nights; an obscure fever 
may be recognized in the after part of the day, the skin being 
dry and husky, and the pulse frequent and hard. For days, 
and even for two or three weeks, the symptoms continue in 
this way, the child being occasionally better for a few hours 
or sometimes for a day or two. Suddenly the pain in the 
head becomes intense; the face is pinched and expressive of 
great suffering; the tongue is red at its tip and edges, dry, 
and its center covered with a white coat; the bowels consti- 
pated, or there is diarrhoea; urine scanty; the pupils dilated, 
and not movable on exposure to light. The child does not 
like to be disturbed, is constantly dozing, though its nights 
are restless. The pulse may be either frequent and sharp, or 
in some cases slow and feeble. Very frequently there is nau- 
sea and vomiting, sometimes very persistent and intractable. 
These symptoms becoming very severe, deep coma results, 
from which the child never recovers, but two or three days 
elapsing from its accession until the fatal termination. 

Diagnosis. — I diagnose this disease by the pinched expres- 
sion of the countenance, every part seeming to be contracted, 
the dilatation of the pupil, the stupor and at the same time 
restlessness of the patient. These symptoms may be con- 
founded with the second stage of inflammation of the brain, 
but the prior symptoms are usually sufficient for the diagnosis. 

Prognosis. — It is very difficult to so describe this disease 
tkat the reader may determine which cases will recover, and 
which will unavoidably prove fatal. Usually, if the child is 



Acute Hydrocephalus. 405 

still conscious, and there is not such marked contraction of 
the countenance as to render it hippocratic, we may hope for 
a favorable result; if the contrary is the case, it will in all 
probability prove fatal. 

Post-Mortem Examination. — The lesions observed in this 
disease are by no means constant. In some cases there is con- 
siderable effusion into the ventricles and the cavity of the 
arachnoid, but in others there is very little or none. Some- 
times there is evidence of determination of blood, and occa- 
sionally small patches of lymph or flocculi in the effused fluid; 
rarely the brain exhibits evidence of slow inflammation. 

" The nature of acute hydrocephalus," says Dr. Bennet, 
"has been keenly disputed, and whether it be inflammatory 
or non-inflammatory, and should be treated with antiphlogis- 
tics or nutrients, will be found to be discussed at great length 
in systematic works and numerous monographs. The fact is, 
that the group of symptoms indicating the occurrence of 
water on the brain is altogether insufficient to prove the exis- 
tence of this morbid product in acute cases. What we observe 
are symptoms of excitement, gradually passing into those of 
depression, occasionally passing into paroxysms of pain, rest- 
lessness or screaming, alternating with drowsiness and coma. 
These symptoms are common to various lesions of the brain, 
and may be the result of mere congestion, or of this state 
terminating in effusion and frequently in exudation. Hence, 
why sometimes after death we find no lesion whatever, at 
others more or less distension of the ventricles with serum, 
and very commonly, in addition, exudation at the base of the 
cranium. In every case, the symptoms are referable not so 
much to one or the other of these lesions as to something 
which they all have in common, and this undoubtedly is more 
or less pressure on various portions of the brain, causing, first, 
irritation and then perversion of function, or so operating as 
to excite some parts and to depress others. In the great 
majority of cases, the fluid distending the ventricles is more 
allied to the dropsies than exudations. Nay, even when 
lymph is thrown out at the base of the brain, the amount of 
serum in the ventricles is altogether disproportioned to the 
quantity of coaguluated fibrin deposited. Hence, I am dis- 
posed to think that even when evidence of so-called inflam- 
mation exists, still the fluid that distends the ventricles is 



406 The Eclectic Practice of Medicine. 

owing to a mechanical obstruction of the vessels, causing 
dropsical effusion. 

Treatment. — The treatment will have to he much modified 
to suit each individual case ; yet, in every one it must he deci- 
dedly stimulant and sustaining. If there is continuous nau- 
sea, with evidence of morbid accumulations, the stomach 
should be relieved by the administration of a prompt emetic, 
very marked benefit following its action. In other cases the 
nausea may be arrested by a sinapism over the epigastrium, 
and the administration of an infusion of Peach-tree bark, or 
Compound Powder of Rhubarb and Potassa. Injections of 
Salt and water, an even teaspoonful to two ounces of water, 
will sometimes prove very efficient in irritation of the stomach ; 
Chloroform and Glycerin may be used for the same purpose, 
and may afterwards be continued in doses of five drops every 
hour or two, for its stimulant and at the same time soothing 
influence. If there is diarrhoea, it is the generally received 
opinion that it should be checked by the use of astringents; 
but this is bad practice, as almost invariably on the arrest of the 
discharges, the coma becomes complete, and the child dies. 

Internally I usually administer, #, Carbonate of Ammonia, 
3j ; Essl. Tincture of Asclepias, f'3ss; Simple Syrup, f3ij; M., 
and give in teaspoonful doses every two hours. Chloroform 
may be added to this in some cases, or it may be given with 
the Brandy. "With the diaphoretic above named, I give 
Brandy to the extent of a teaspoonful every hour, to a child 
two or three years of age, the dose being sometimes increased 
and sometimes diminished. The hot Mustard foot bath will 
be sufficient in some cases, if thoroughly used, but if the case 
is severe, I prefer a tub of water as hot as the child can bear 
it, and rendered stimulant by the addition of Mustard or Cap- 
sicum, into which I sit the child, letting it remain from half 
an hour to two hours. Dry cupping to the neck, and even 
sometimes to the entire spine, is among our most important 
measures; sometimes the cups to the neck may be scarified, 
especially if there is much heat of the head. A sinapism to 
the neck and spine will sometimes answer the purpose, but is 
not as good as the cups, and I think not as useful as friction 
with strong Salt and water. If the kidneys fail to act freely 
I would administer an infusion of Hair-cap Moss or of Marsh- 
mallows, with a suitable portion of Acetate of Potassa and 
Sweet Spirits of Nitre. 



Chronic Hydrocephalus. 407 

Just as soon as a change for the better is noticed, marked 
by returning consciousness, less restlessness and the establish- 
ment of the secretions, we would administer Quinia and 
Hydrastin, one grain of the first and half a grain of the second, 
to a child two years old, every three hours until three doses 
are taken ; the best time to give it being usually in the fore- 
noon. The Brandy should not be omitted until convalescence 
is completely established, and with it the patient should have 
a nutritious diet of milk or animal broths. Usually the diar- 
rhoea ceases with the commencing amendment; if it does 
not, the case may be treated as named under the head of diar- 
rhoea and cholera infantum. In some very severe cases the 
Iodide of Potassium has been given with good results. Dr. 
Roeser reports a case in which " the child lay quite insensible, 
pupils fixed and dilated, complete paralysis of one side, face 
flushed, body bathed in perspiration, and all the other symp- 
toms denoting the last stage of the disease. One drachm of 
the Iodide of Potassium was dissolved in half an ounce of 
water, thirty drops of this solution were given every hour in 
a little water ; one drachm of the Iodide was at last given in 
twenty-four hours, and then the good effect appeared ; in short, 
the child rapidly recovered, without any other bad effect than 
a crop of boils." Cold affusion has been recommended when 
coma was complete, but though successful cases are reported 
I should not like to try the remedy. 



CHRONIC HYDROCEPHALUS. 

Dropsy of the brain is almost exclusively a disease of child- 
hood, and occurs most frequently before the third year. It is 
difficult to determine the causes that give rise to the effusion 
of water from the arachnoid, but as it occurs almost invariably 
in children of feeble vitality, and in families whose children 
die during infancy of acute hydrocephalus, cholera infantum, 
or this, we are led to believe that it depends upon hereditary 
debility. The exciting cause may be the exanthemata, whoop- 
ing-cough, disease of the bowels, or some inflammatory 
disease, or it may arise from depression produced by cold and 
other causes. 

Symptoms. — The symptoms vary very greatly, the disease 
running a tolerably rapid course in some cases, and a very 



408 The Eclectic Practice of Medicine. 

slow one in others. The child usually complains of its head, 
if it can talk, or moves it from side to side, putting its hands 
to it frequently. The face is pallid and contracted, or in 
some cases puffy and without expression; the circulation 
is feeble, the extremities being cold, and the surface easily 
chilled ; the appetite is irregular, sometimes, good, at others 
very poor, and digestion seems to be feeble ; the bowels are 
torpid and constipated, though sometimes irregular. As the 
disease progresses, we notice that the child is very stupid, 
and that at times it has difficulty in controlling the voluntary 
muscles ; there may be temporary or permanent strabismus, 
and an involuntary rolling about of the eyes, with a dilated 
and fixed pupil. 

Occasionally we observe a marked irritability of the stom- 
ach that is with difficulty controlled ; and in some cases an 
extreme irritability and restlessness, though the intellectual 
functions are greatly impaired. As the disease progresses the 
torpor becomes deeper, and the child does not exhibit the 
symptoms of pain above named. The pulse is now seen to be 
getting perceptibly weaker, and occasionally irregular; the 
hands are tremulous and unsteady, and frequently raised to 
the back of the head. When the child sleeps its eyes are half- 
open, and the eyeballs are constantly moving and usually 
drawn upwards. When the torpor is not so great, the child 
is in some cases constantly picking its nose or lips, and is 
extremely irritable, having paroxysms of rage from the slight- 
est supposed offence. The disease may continue this way for 
months, or in some rare cases for years, finally terminating 
fatally by the development of some ataxic disease, or of acute 
hydrocephalus, or with a gradually developed marasmus. 

Diagnosis. — In very young children, and sometimes up to 
the age of three years, there will be found a perceptible 
enlargement and distension of the fontanelles, and separation 
of the sutures, and the child's head is appreciably larger. 
After this, we are guided entirely by the general symptoms 
above named. 

Prognosis. — The prognosis is usually unfavorable, though 
some cases may be cured, and in others life may be prolonged 
for a considerable period. Cases are recorded in which the 
persons lived to an adult age, and in four cases to 27, 32, 45 
and 54 years. 

Post-Mortem Examination. — If the disease has been of long 



Chronic Hydrocephalus. 409 

duration, the bones of the cranium will be found thin and 
transparent, and occasionally separated from each other by 
very considerable intervals. The effused fluid is found in the 
sac of the arachnoid, and in the ventricles ; if in the ventricles 
to a great extent, the convolutions are unfolded, and the 
medullary and eineritious substances can with difficulty be 
distinguished. The brain is often denser than usual, and is 
not diminished in weight. 

Treatment. — The most successful plan of treatment in these 
cases is that which will to the greatest extent, increase the 
tone and vitality of the system, and at the same time keep 
the secretions free. As in the acute form of the disease, 
Asclepias and Carbonate of Ammonia, will frequently be all 
that is necessary to keep the skin and kidneys in action, and 
quiet irritation. As a tonic, Quinia and Hydrastin answer 
the best purpose, and when there is constipation of the bowels 
may be given with Podophyllin, in small doses, the combina- 
tion of these remedies heretofore given may be employed. 
The Collinsonia Canadensis is a favorite remedy in my prac- 
tice, especially in cases where there is irritation of the nervous 
system, and we may associate with it the Ptelea, Cornus, 
Euonymus, or other remedies of this class. I use them in the 
form of the Essl. Tincture, or if I prepare it myself, a satur- 
ated tincture. Bye- Whisky or Cod-liver Oil are excellent 
when the stomach bears them kindly, and should it reject the 
Oil, its place may be supplied by Sweet Cream or Beef-suet. 

The child should have a daily Salt-water bath ; sometimes 
the entire bath will be best, and may be used either warm or 
cold, the first being generally preferable, or the sponge bath 
may be used; in either case, it should be followed with brisk 
friction. The child should be taken out in the open air every 
day, being warmly clad in flannel. If possible it should be 
removed to a high locality in the country, where it can have 
pure air and sunshine, exercise and pure milk. 

I doubt the propriety of using vesicants to the scalp, or in 
fact to any part of the body, as it seems to me that the irri- 
tation of the system thus induced more than balances any 
good that might result from it. Croton Oil, with Turpentine, 
3j to 3ss, has been used, being freely rubbed into the scalp every 
four hours until vesication was produced; or a liniment of 
Ipecac, as # Ipecac, Pulv. Olei Olivse Europ., aa, 3ij ; Adipis 
Suillus, 3ss; M; it should be rubbed into the scalp for fifteen 



410 The Eclectic Practice of Medicine. 

or twenty minutes, and the part then covered with flannel. 
Strapping the head has heen recommended, as has also com- 
pression with bandages, and I can conceive cases in which 
this treatment might be advantageous. As a last resort, tap- 
ping has been recommended, and some cases are reported in 
which it was successful; carrying the matter still further, it 
has been proposed to inject Tincture of Iodine, fifteen minims 
to two ounces of water. 



SPINAL MENINGITIS. 

Inflammation of the meninges of the spinal column is not 
an uncommon disease, though sometimes from the obscurity 
of its symptoms it may be mistaken for other affections. It 
occurs in two forms, as a distinct sporadic inflammation, and 
as an epidemic or endemic fever which owes its origin to the 
spinal cord. It is in the last named cases that mistakes in 
diagnosis are most usually made. The causes of this affection 
are those which give rise to other inflammations, as cold, sud- 
den changes of temperature, injuries, and especially a sudden 
chilling of the surface after active exertion. It occurs most 
frequently in the young and vigorous, and is very rare after 
middle life. 

Symptoms. — Spinal meningitis usually commences with a 
well-marked chill, lasting for several hours, though some- 
times with a severe rigor of considerable duration. I have 
seen cases in which the chill was of twenty-four hours dura- 
tion, the latter part of it being alternated with flushes of heat. 
Following this, there is marked febrile reaction, with hot, dry 
skin, hard and frequent pulse, tongue coated white, the edges 
and tip being red, constipation of the bowels, and scanty and 
high-colored urine. The patient complains greatly of pain in 
the back, which is so increased on movement, that he dislikes 
to change his position for any purpose; though in some cases, 
when not so severe, they are constantly shifting their position 
to give them ease. By the second or third day the fever 
usually becomes high, the pulse running some thirty or forty 
beats higher than in health, the skin being very dry and con- 
stricted, and the irritability and restlessness marked. These 
symptoms may be so prominent as to completely overshadow 
the symptoms of spinal inflammation, the patient not even 



Spinal Meningitis. 411 

complaining of the pain, unless his attention is directly called 
to 'it. It will be noticed, however, that the slightest move- 
ment or changing the position of the body gives rise to pain, 
and when the attention is thus drawn to it the soreness of the 
spine will be continually noticed. Deep pressure usually 
elicits tenderness, and sometimes the sensibility is so exquisite 
that the patient can not bear to be touched. 

As the disease progresses, the fever assumes an irritative or 
typhoid type. The tongue soon becomes brown, and sordes 
appear on the teeth. T3^phomania occurs about the sixth or 
seventh day, and is frequently attended with looseness of the 
bowels. Sometimes there is marked irritation of the brain 
and delirium, at others a stupor which soon passes into deep 
coma. As the local disease progresses, it is found that the 
lower extremities are subject to involuntary movement, and 
that the patient has but partial command over them; and 
that the bladder and rectum is evacuated without the know- 
ledge of the patient, or there is retention of urine without 
the power of discharging it. At last, in severe cases, paralysis 
of the part below the seat of inflammation is complete. The 
fever is usually continued, though sometimes remittent, and 
is invariably ataxic, presenting well-marked typhoid symp- 
toms, with the exception of diarrhoea, by the tenth to the 
twelfth day. It is usually protracted, lasting from two to 
eight or ten weeks. 

Diagnosis. — We diagnose inflammation of the spinal cord 
by the marked tenderness of the spine and inability to move, 
the constant pain in the back with the severe attendant fever. 
It is almost impossible to overlook these local symptoms, and 
yet in many cases they have been disregarded, to the great 
detriment of the patient. 

Prognosis. — The prognosis is usually favorable if treatment 
is commenced in time, but is unfavorable after it has made 
progress for several days, in many cases terminating fatally, 
or in paralysis. 

Post-Mortem Examination. — In some cases there is marked 
evidence of determination to the membranes and enlargement 
of the vessels. Sometimes the membranes are thickened, 
and fragments of organized lymph on the free surface; there 
may also be flocculi in the fluid of the spinal cord, which is 
increased in quantity. In other cases the disease seems to be 
confined to the pia- mater and the substance of the cord, the 



412 The Eclectic Practice of Medicine. 

former being slightly reddened, and sometimes thickened, and 
the latter softened, sometimes so much as to have lost all 
traces of organization. 

Treatment. — In many cases it will he advantageous to com- 
mence the treatment with an emetic, especially if, as in some 
cases, there are symptoms of morbid accumulations or nausea. 
Following this, I should use the warm bath for an hour or 
two, or the vapor bath; or if the skin was hot, I should not 
hesitate to resort to the wet sheet pack. The special sedatives 
may be given from the first, Tinctures of Aconite and Vera- 
trum being the agents selected, and given in small doses and 
frequently repeated, as heretofore recommended ; Tincture of 
Gelseminum may be used in full doses until its specific in- 
fluence is produced, as its action in preventing determina- 
tion to the nervous centers is more marked than any other 
agent. Associated with these remedies, we would direct wet 
cups to the spine, followed by hot fomentations of Hops or 
Stramonium, or in some cases rubefacient applications, as 
Mustard or the stimulating liniments. 

We will usually have to continue the above measures for 
two or three days, and sometimes longer, before any very 
perceptible influence is produced. We may add to the treat- 
ment named, a solution of the alkaline diuretics about this 
time, and may also commence the administration of Quinia. 
The treatment would now be the special sedatives to the 
extent of controlling the pulse. The Tincture of Gelseminum 
in small doses, with a diaphoretic, as the Asclepias, a solution 
of the alkaline diuretics, and Quinia and Hydrastin in the 
forenoon, the dose being proportioned to the age and condi- 
tion of the patient. The frequent use of the sponge bath 
gives the patient great relief, and aids the action of our 
remedies. The bowels should be kept in a soluble condition 
by the use of some mild cathartic; I prefer Podophyllin 
thoroughly triturated with twenty times its weight of white 
Sugar, and with the addition of Cloves or Ginger to prevent 
its griping. If the patient seems much debilitated, as is fre- 
quently the case, Brandy or Rye "Whisky should be used to 
such an extent as to give the necessary stimulation, but not to 
overcome the effects of the sedatives. 

Quinia has a very singular influence in some cases; if given 
in large doses it produces marked sedation and exhaustion, 
and if continued this way for a few days, it may be followed 



Spinal Irritation. 413 

by an irritative fever, with sharp, quick pulse and dry skin. 
For an adult, from six to ten grains daily is as much as will 
generally be of advantage; and a child of ten years may 
usually take from four to six grains. Opium may be given 
with advantage after secretion is established ; in children I 
use the Compound Powder of Ipecac and Opium. The cups 
to the back may be repeated two or three times, or after their 
first use we may continue the stimulant applications, I am 
impressed with the opinion that we will find the wet bandage 
a most efficient application in many cases, and that it may 
advantageously take the place of stimulant applications. 
Further than this, the patient will have to be managed as 
in continued fever, the strength being supported with stimu- 
lants and nutritious food in the shape of milk and animal 
broths, and an equal circulation of the blood carefully main- 
tained. If there is tendency to paralysis as the patient 
recovers the treatment hereafter named may be immediately 
adopted. 

SPIRAL IRRITATION". 

Irritation of the spinal cord is met with quite frequently, 
and is usually associated with some chronic affection, and 
stands in relation to it either as cause or effect. In some 
of these cases there is undoubtedly a chronic inflammation, 
in others an irritation with determination of blood, and in 
another class there is feeble circulation and nutrition, the irri- 
table action being the result. As these conditions are differ- 
ent, and demand different treatment, the importance of dis- 
tinguishing them will be apparent. 

The causes of spinal irritation are various. In some cases 
it results from injury, in others from cold, and in others from 
change in the circulating fluids. The most frequent cause is 
undoubtedly the extension of an irritation from some organ 
or part along the nerves supplying it back to the spinal cord. 
This most frequently occurs from parts supplied from the 
great sympathetic nerve, the irritation being transmitted 
backward to the ganglia, and thence by the fibers of com- 
munication to the spinal cord immediately back of them. 
Hence, the frequency with which we find spinal irritation in 
chronic visceral disease, especially if of long standing. As 
examples of this, we might enumerate irritation of the lower 



414 The Eclectic Practice of Medicine. 

lumbar region and sacral portion from disease of the genito- 
urinary organs, the lower dorsal in disease of the kidneys, the 
upper dorsal in disease of the stomach, liver and spleen, and 
of the cervical in disease of the heart. This is so constant 
that we are almost certain if we find irritation of these por- 
tions of the spinal cord, manifested by tenderness, or abnor- 
mal nervous manifestations in the sensory and motor nerves 
distributed from these parts, that the organs supplied from 
the sympathetic ganglia in front are the subject of either 
functional or structural disease. Indeed, it has been pro- 
posed to diagnose disease in this way, and sometimes it will 
direct our attention to disease of the viscera that otherwise 
would have been overlooked. 

Not only will disease of the organs thus supplied give rise 
to an irritation of the spinal cord in the manner named, but 
the spinal irritation when once started may be sufficient to 
continue the disease, in spite of any treatment directed to it, 
and in some cases when the original disease is stopped by 
remedies it will reproduce it. Normal innervation is of pri- 
mary importance to the healthy performance of function, 
hence the many functional lesions that follow irritation of one 
of the principal nervous centers. It is for these reasons that 
we are so anxious to determine the existence of spinal irrita- 
tion, and to adopt measures for its relief. 

Symptoms. — The symptoms vary very greatly, according to 
the part affected, its intensity, and to the progress it has made. 
Usually, but a portion of the spinal cord is involved, and in 
such case we have the manifestation of abnormal innervation 
in parts supplied with nerves from that source. Thus, in 
spinal irritation attending uterine disease, we will find with 
the smallest amount of structural or functional disease the 
most exaggerated sufferings. It is in such cases that we have 
the severe dragging and bearing-down pains, the difficulty 
and pain in passing urine, the pains passing to the arms and 
simulating hip disease, and extreme restlessness and irritabil- 
ity witnessed in such cases. So it is in cases of dyspepsia, 
disease of the liver, and heart disease. We witness an exag- 
gerated form of the disease in cases of spinal irritation induced 
by onanism, or in some cases the irritation induced being of 
the medulla oblongata, the effects will be seen in organs sup- 
plied by the pneumogastric nerve, and the first cervical sym- 
pathetic ganglia. 



Spinal Irritation. 415 

Dr. Tilrck, of Vienna, remarks : " If we were to attempt an 
illustration of our remarks as to the diagnosis, we could not 
take a more apt instance than that of abdominal tenderness. 
When it depends upon spinal irritation, it will he found that 
the history of the patient presents instances of her having 
previously suffered from neuro-emic affections. The affectible 
state of the cutaneous nerves of the abdomen is never observed 
to occur alone, the nerves of the abdominal viscera suffer also. 
The kidneys, for example, secrete less or more urine than nat- 
ural; if less, the deficiency amounts occasionally to complete 
ischuria; if more, the urine is pale and diabetic. And so 
there is oue or the other of the two opposite states of consti- 
pation and diarrhoea, but more usually constipation, with 
spasm of the colon, giving rise to colic. In the more aggra- 
vated cases, the motor nerves of the large intestines, bladder, 
abdominal parieties, and lower extremities, are also affected; 
and tympanitis, vesical paralysis, constipation and paraplegia 
ensue. The tenderness experienced is not simply tenderness 
on pressure, but it is a tenderness to the slightest touch, and when 
there is spinal tenderness, for it is not always present in these 
cases, the tenderness is of the same kind. The abdominal 
tenderness of peritoneal and visceral inflammation differs 
altogether from the preceding, both in its history and con- 
comitant symptoms. It is rarely seen in neuro-emic females, 
except when the cause is quite manifest; as, for example, 
where there is chronic structural disease of the peritoneum or 
abdominal viscera, accompanied by inflammation, or when it 
appears in parturient females as a symptom of metritis. We 
believe the neuro-emic state is rarely coincident with struc- 
tural disease within the abdomen, or terminates in it." 

In gastric and hepatic disease we find the same class of 
symptoms, the evidence of suffering being out of proportion to 
the extent of functional lesion determined by close examina- 
tion. Here the manifestations of the spinal disease so closely 
simulates dyspepsia in its various forms, that were it not for 
the exaggeration of the symptoms as compared with the known 
imperfection of the digestive process, we would be frequently 
mistaken. As it is, we are not only surprised to see such 
marked symptoms attendant upon comparatively slight de- 
rangement of digestion, but more so, perhaps, that the admin- 
istration of remedies in which we had placed the greatest 
confidence had failed of producing any benefit. I recollect a 



416 The Eclectic Practice of Medicine. 

case of this kind, in which the patient complained of an 
exquisite burning in the stomach with marked tenderness on 
pressure over the epigastrium, with the occurrence of vomit- 
ing if much food was taken, and once or twice daily in any 
event, these symptoms being of seven years' standing. She 
had been treated for ulceration and other structural disease 
of the stomach without avail, and finally came into my hands. 
Accident more than critical examination led me to examine 
the spine, which was found tender on pressure through the 
entire dorsal region ; the application of the irritating plaster 
to the spine cured the patient in six weeks. 

Functional heart disease is not of unfrequent occurrence 
from this cause, and in some cases is so severe as to endanger 
life. The spinal irritation in these cases is of the cervical 
region. The lungs may also be implicated in the same man- 
ner, giving rise to cough, difficulty of breathing, and expecto- 
ration. The organs of special sense are intimately associated 
with the upper cervical portion of the spinal cord, and I am 
satisfied that a principal reason of the perversity of some of 
them will be found in spinal irritation. Why do we use 
counter-irritation to the back of the neck in disease of the 
eyes and ears ? Because it answers a better purpose there 
than any where else, and it does this, as we believe, for the 
reasons stated. 

Diagnosis. — The diagnosis of spinal irritation is easy, when 
we are led to believe that it exists from the disproportion 
between the apparent symptoms and the real evidences of dis- 
ease, and when on examination we find tenderness on pressure 
over the spine. In other cases, the similarity of the symptoms 
to acute, and more frequently chronic inflammation of organs, 
and the absence of physical signs of such disease, will be our 
guide. The case will frequently have to be watched for several 
days before an opinion can be given. 

Prognosis. — The prognosis is usually favorable, yet we occa- 
sionally find cases in which it is impossible to reach the 
disease. 

Treatment. — In cases in which there is decided determina- 
tion of blood to the spinal cord, I should apply the irritating 
plaster, and continue it so as to produce irritation but not 
suppuration ; in some cases the suppurative action is beneficial. 
Associated with this, we might employ the Tincture of Gel- 
seminum, Tincture of Macrotys and Tincture of Colchicum, 



Curvature op the Spike. , 417 

equal parts of each in doses of half a teaspoonful every four 
hours, with Iodide of Potassium, and some vegetable alterative, 
as the Compound Tincture of Corydalis, or Compound Syrup 
of Stillingia. In some cases, better results will follow a solu- 
tion of Acetate of Potassa with very small doses of Tincture 
of Aconite. 

If it should be judged from the torpor of the parts to which 
spinal nerves are distributed, and especially from languid circu- 
lation in the parts, that there is congestion of the spinal cord, 
a different treatment will be advisable. Here, friction to the 
spine with the use of salt water will be better than counter- 
irritation, and in place of the remedies above named, I would 
use ISTux Vomica, Quinia, Belladonna, Staphisgria, Rhus 
Toxicodendron, or Ergot, as was indicated by the individual 
case. The pill of Nux Vomica, Quinia, Hydrastin and Podo- 
phyllin presents a very good combination. 

In the last case, when dependent upon feeble nutrition, we 
may use stimulant friction to the spine, and when it seems to 
be the only part of the body so affected, counter-irritation may 
be used to parts adjacent. Bromide of Ammonium, Carbonate 
and Hydrochlorate of Ammonia, the Hypophosphites, Cod- 
liver Oil, Quinia, Nux Vomica, and the bitter tonics, are valu- 
able remedies. I like the action of the Collinsonia in these 
cases, and have used with advantage the Mitchella, the 
Senicio, and Santonine will be found useful in cases of irritation 
of the lumbar spine, with disease of the urinary organs. 

In addition to the means above named, we usually adopt 
the treatment appropriate for the visceral disease. All inter- 
nal remedies should be given in small doses and continuously, 
giving plenty of time for their effects to become manifest 
before changing them for others. 'No plan of treatment will 
be successful unless the hygienic condition of the patient is 
attended to ; if possible she should have pure air, out-door 
exercise, a nutritious diet, and agreeable mental occupation ; 
these in many cases are as important as the appropriate 
remedies. 



CURVATURE OF THE SPIKE. 

Curvature of the spine occurs most generally in the young, 
and is rare after the age of twenty-five. In all cases it is the 
result of enfeebled vitality, either congenital or induced by 

27 



418 The Eclectic Practice of Medicine. 

destitution or over-mental exertion or sexual excitement. In 
some cases this manifests itself in the form of scrofula or 
tuberculosis, and in such case we may expect disease of the 
bones. Two varieties of curvature are met with, lateral and 
posterior, both occurring most frequently in the dorsal region, 
though at last always compensated by curvature of the lum- 
bar and cervical portions. 

Lateral curvature may be dependent upon affections of the 
muscles, as hypertrophy, atrophy, spasmodic contraction or 
inflammation ; upon general debility, the body not being suf- 
ficiently strong to support itself in the erect position; upon 
obliquity of the pelvis, the result of injury or disease of the 
lower extremities ; or upon altered capacity of one side of 
the chest; upon rachitis or softening of the bones, or defect- 
ive development of the vertebra. Posterior curvature is most 
generally dependent upon disease of the bodies of the vertebra, 
though in some cases it undoubtedly results from debility, 
and the habit of throwing the head and shoulders forward in 
sitting and walking; in the last case being very mild. Prac- 
tically we have to study the case : first, with reference as to 
whether its depends upon disease of the muscles or bones; 
second, whether its continuance depends upon determination of 
blood or upon feeble circulation ; and third, as regards the 
general health, whether there is simple debility from imper- 
fect digestion and assimilation, or a scrofulous or tubercular 
cachexia. The success of the treatment will depend upon 
accurate diagnosis as regards these points, as in many respects 
it must differ in different cases. 

Symptoms. — The symptoms of curvature of the spine vary 
greatly in different cases, in some being very marked, in 
others obscure. Usually the child's health is noticed to be 
feeble, its appetite variable, and digestion and assimilation 
imperfect. It may or may not complain of pain in the back, 
but it will be noticed that the back is weak and that it makes 
unusual efforts to rest it, In lateral curvature, the disease is 
most usually dependent upon local debility of the erector 
muscles of the spine, and there is frequently no complaint, 
except from weakness of the back, and the symptoms of gen- 
eral debility above named. If partially owing to spasmodic 
action, pain would be a constant attendant, though usually 
there would be no tenderness on pressure. If the result of 
disease of the bones, as in most cases of posterior curvature, in 



Curvature of the Spine. 419 

addition to more or less pain, there will be tenderness on deep 
pressure. In these cases the disease of the bone causes irrita- 
tion of the spinal cord, and we have the symptoms heretofore 
named. 

Diagnosis. — An examination of the spine will determine 
the existence of curvature, and it is usually not difficult to 
determine which is the primary and which is the curvature of 
compensation. In almost all cases of lateral curvature we 
will find the fault to exist principally in the muscles at first, 
though as the disease progresses irritation is frequently 
developed, resulting in spasmodic action, and finally in atro- 
phy or softening of the bones ; hence spinal tenderness will 
usually result in the latter part of the disease, and* not at its 
commencement. In posterior curvature, we sometimes have 
the most marked evidence of scrofulous cachexia, and in most 
cases we have marked general debility. It will be recollected 
that the disease of the bodies of the vertebra may be a true 
inflammation, or result from deposit of tubercles and scrofu- 
lous material, or may be simple softening from rachitis. In 
the first case the pain will be marked and decided, in the 
second there is simple irritation and aching of the part, 
with tenderness on pressure; and in the last we will have 
the previous curvature and deformity of the legs and pelvis, 
in addition to the absence of pain and tenderness, to aid 
us in the diagnosis. Mr. Solly believed that softening of 
the bones might be entirely local, and might be dependent 
upon nervous exhaustion ; in such case the symptoms would 
be obscure. 

Prognosis. — In lateral curvature a favorable prognosis may 
be given in many cases, the deformity being nearly entirely 
removed, or it may be simply arrested, the body so accommo- 
dating itself to it as to give rise to but little subsequent 
trouble. In posterior curvature the best result usually obtain- 
able is to stop the disease and prevent further curvature. It 
is true that in some cases we may partially correct the deform- 
ity, but in a large majority the attempt is attended with injury 
rather than benefit. If there has been destruction of the 
bodies of the vertebra the best result is anchylosis of the 
bones and of course permanence of the curvature ; and if this 
is prevented by instruments for extension, the life of the 
patient will almost surely be sacrificed. 

Treatment. — In all forms of spinal curvature attention to 



420 The Eclectic Practice of Medicine. 

the general health is one of the most important points in the 
treatment. Those bitter tonics that improve the tone of the 
stomach, and give the patient a good appetite and power of 
digestion are applicable. I like the effect of the Essl. Tinc- 
tures of Hydrastis, Collinsonia, Cornus and Ptelea; but in 
some cases the Hydrastin and Quinia, with a small portion of 
Podophyllin and the Extract of E"ux Vomica if there is nothing 
to contra-indicate it, will be found best. Iron in some form is 
usually necessary, and though most writers recommend the 
soluble preparations, I prefer the Carbonate or Phosphate. If 
there is disease of the- bones assuming the form of softening, 
Phosphoric Acid has been recommended; and from the little 
experience I have had with it, I am inclined to believe that it 
will generally be found advantageous; we would commence its 
administration in doses of two drops of the dilute acid, four 
or five times a day, and increase it if deemed best. 

"When the symptoms would lead us to believe there was 
scrofulous disease of the bones the vegetable alteratives will 
be brought into requisition. A combination of Yellow Dock 
and Tag Alder, with small portions of Acetate of Potassa has 
answered my purpose well. The Compound Tincture of 
Corydalis is very efficient, and may be combined with Iodide 
of Potassium. If there is great irritability of the nervous 
system I would substitute the Bromide of Ammonium for the 
pieparations of Potassa. These remedies should not take the 
place of tonics and restoratives, but should be associated with 
them in such manner as that normal digestion and assimila- 
tion shall be the first object in view. A nutritious and easily 
digested diet should be prescribed, and frequently a small 
amount of malt liquor is advisable. The spouge bath should 
be used daily, sometimes of simple water, salt and water, or 
stimulants, as Capsicum or Mustard, or the mineral acid 
baths, or of a decoction of the bitter tonics and astringents. 

If there is simple loss of muscular power, as in many 
cases of lateral curvature, we would recommend open air 
exercise, and friction of the spine with cold salt water, and 
sometimes the use of Electricity. These are the only cases in 
which exercise is permissible and then it should be so regu- 
lated as not to prove exhaustive. Sir B. Brodie recommends 
that the muscles of the back be strengthened by climbing and 
other exercises, for which in delicate girls friction or sham- 
pooing for an hour or two daily might be substituted; and 



Curvature of the Spine. 421 

the patient should lie down for a part or a whole of the time 
she was not engaged in exercise. Mechanical support may be 
used in these cases, but it should always permit free move- 
ment. If in any case there is irritation and pain, with ten- 
derness on pressure, the child should maintain the recumbent 
position, and especially is this the case in posterior curvature. 
Rest is all-important in these cases, until the disease is entirely 
arrested, and though it will sometimes ^eem as if the child 
could not bear the continued confinement, we will find that it 
absolutely improves in every respect while maintaining the 
most perfect quiet. Counter-irritation is of much importance 
in these eases, but we must be careful not to carry it so far 
as to unduly irritate the nervous system, or induce debility by 
the excessive discharge. The irritating plaster is a favorite 
application, and will usually be found the best of any. It 
may, in severe cases, be replaced by the issue, and in others by 
two, three or four small setons, as common surgeons' silk, 
passed through a fold of the skin on each side of the spine. 
In cases of disease of the bones, Dr. Pirrie remarks: 
"That any attempt to remove the curvature would be inju- 
dicious. Anchylosis is the only favorable termination to be 
hoped for, and therefore the object to be aimed at in treat- 
ment should be to place the patient under circumstances most 
likely to conduce to that result. "With that view, it is indis- 
pensable, first to keep the patient in a recumbent position, so 
as to remove from the diseased parts the pressure of the 
superimposed weight, and to preserve the parts in a state of 
perfect quietude in that position; and secondly, to use all 
means, judicious and available in the circumstances of the 
ease, for maintaining the general health. One particular 
advantage which results from preserving the parts at perfect 
rest in the horizontal position is that the removal of the irri- 
tation caused by the superincumbent weight from the diseased 
parts diminishes the danger of the formation of abscess, 
which is a most unpromising occurrence, and must induce the 
gloomiest apprehensions as to the ultimate result." 

A most excellent means of attaining perfect rest is afforded 
by a common camp cot, with the head elevated about a foot, 
and covered with a soft hair mattress ; two crutches softly 
padded, should pass from the foot up to the arm-pits, and an 
india-rubber webbing attached to the arms of these to support 
the trunk. In this apparatus there is constant gentle exten- 



422 The Eclectic Practice of Medicine. 

sion ; the body is supported by the webbing, the patient lying 
on the back, or face downward, as seems best suited to the 
case. For full description the reader would do well to consult 
Bigg on Deformities, the second volume containing most 
explicit descriptions of apparatus and well drawn wood-cuts. 



APOPLEXY. 

Apoplexy may occur at any age, bu.t is much more frequent 
after middle life than before, and occurs more frequently in 
the male than in the female. It is in all cases dependent 
upon lesion of the brain, though this is not always manifest, 
and may be induced by various causes. In the severe cases 
there is extravasation of blood, cerebral hemorrhage, or other 
organic disease producing pressure; in the milder forms it 
may be dependent upon congestion. The fact that tonic 
contraction of the muscles of the neck existed in all cases has 
been taken as conclusive evidence that this, by preventing the 
free flow of the blood from the brain by the jugular veins, 
was the cause of the convulsions, and of the extravasation of 
blood afterwards found. The popular impression, and to 
some extent the opinion of the profession, that a condition of 
plethora, with a full habit of body, florid face, and short neck, 
was necessary to apoplexy, is incorrect, as the disease occurs 
quite frequently in persons the very opposite. Thus, in sixty- 
three cases described by M. Rachoux, ten were plethoric, 
twenty-three were thin, and thirty were of ordinary habit of 
body. 

Among the causes giving rise to apoplexy we will find 
that diseases of the heart exercise an important influence, 
either sending the blood to the brain with increased force, or 
preventing its free return. Some authors have contended 
that previous disease of the blood vessels of the brain was an 
important element of apoplexy, and that in a majority of 
cases they had undergone fatty or other degeneration. The 
exciting causes are various, as intense emotional excitement, 
intemperance in eating and drinking, and long continued 
and exhausting mental or physical exertion. Possibly the 
most frequently exciting cause is undue distension of the 
stomach by eating, when the system has been previously 



Apoplexy. 423 

exhausted by mental exertion, or when the system is 
enfeebled from other causes. 

Symptoms. — Apoplexy may be sudden in its occurrence, or 
may be preceded by premonitory symptoms. In the last case, 
for a few hours, or even days, the patient feels an unnatural 
weight and tightness of the head, ringing in the ears, and 
occasional inability to control the voluntary muscles. These 
symptoms may be constant, or may last but a moment and 
then pass off; they are not definite, but should cause suspicion 
of danger of an apoplectic seizure. In other cases, the patient 
is suddenly attacked with dizziness and vertigo, with ringing 
in the ears, disordered vision, and partial or entire loss of con- 
sciousness for a few moments ; afterwards hd feels dull and 
stupid, can not arouse himself, staggers when he walks, his 
voice is thick and husky, and he reasons with difficulty. These 
symptoms occurring after a full hearty meal, or after great 
excitement, are indicative of a serious apoplectic attack. In 
other and possibly the majority of cases, there is nothing to 
warn the patient or friends of the approaching danger. 

The attack of apoplexy is sudden, the patient losing all 
consciousness instantly, and falling wherever he may be situ- 
ated; tjhe countenance is livid, there is relaxation and immo- 
bility of the muscles, or a semi-rigid condition, stertorous 
respiration, and a slow, full and sometimes hard pulse. There 
is complete arrest of volition, and of the influence of the brain 
over the body, the patient lying in any position in which 
he may be placed, and only those functions, respiration and 
the circulation of the blood, which are dependent upon the 
spinal cord and sympathetic ganglia are carried on. In some 
cases the shock is so great that the extremities become cold and 
livid, and a cold, clammy perspiration breaks out over the entire 
surface. In other cases the attack is not so severe, there being 
slight spasmodic movement, and in ability to swallow. In those 
cases in which there is a mild premonitory attack, the symp- 
toms of cerebral disturbance continuing, we may expect 
the severe paroxysm with the aggravated symptoms above 
named, and very generally a fatal result. 

The apoplectic seizure may last but a few moments in mild 
cases, the patient slowly recovering consciousness and power 
over his body; or it may be very greatly protracted, lasting for 
hours,.or terminating in a deep coma with more or less para- 
lysis, from which the patient slowly recovers ; or the coma 



424 The Eclectic Practice of Medicine. 

deepens and lie dies some days after the first attack. Paraly- 
sis is of tolerably frequent occurrence as the result of apoplexy, 
and most usually takes the form of paraplegia. 

Diagnosis. — Apoplexy is usually diagnosed with ease, when 
we can get the previous history of the patient. The sudden- 
ness of the attack, the person being apparently in good health, 
complete loss of consciousness, flushed face, stertorous respira- 
tion, complete immobility and slow full pulse, are symptoms 
that can not be mistaken. Complete intoxication, or what is 
popularly known as "dead drunk," may be mistaken for apo- 
plexy; the only means we have of determining the difference 
in some cases being the smell of liquor on the breath, and the 
tendency to vomit and character of the material brought up. 
Most generally we are able by moving the patient to elicit 
some sound, showing that it is not apoplexy. In concussion 
of the brain there is no possible means of diagnosis, except the 
injury of the head, and very frequently this is not perceptible, 
or seemingly no more than might have resulted from the fall 
during the apoplectic seizure; as we have to be guided entirely 
by the history of the case, the fact of the patient's having 
received a fall or blow sufficient to have produced concussion, 
must be taken into consideration. It makes no difference in 
the treatment whether the diagnosis be made or not, but it is 
frequently of the greatest importance in reference to a criminal 
trial. Epilepsy and hysteria can not be mistaken for apoplexy, 
for in both there is convulsive movement, and in the first? 
frothing at the mouth; it is true that the coma of the second 
stage might sometimes be so mistaken, as might the coma 
following inflammation of the brain, had we not the previous 
symptoms to guide us. 

Prognosis. — Apoplexy is always a dangerous disease, though 
very many persons^recover from a first attack. The patient 
may die almost immediately, or may live for two or three days, 
or finally die during reaction. In many cases the apoplectic 
seizure is followed by paralysis, usually paraplegia. We fear 
a fatal result when the respiration is very slow, labored and 
stertorous, with a weak pulse, a cold perspiration, and invol- 
untary discharges of the fasces and urine. If the disease has 
continued over twenty-four hours, with continued deep coma, 
we have but little hopes of recovery. So, also, in cases in 
which the coma having partly passed off, the patient becomes 
delirious, and frequently puts his hand to a determinate part 



Apoplexy. 425 

of the head. The prognosis is favorable in cases in which the 
respiration gradually becomes less stertorous, the surface and 
extremities warm, and the pulse full and of normal frequency. 

Post-Mortem Examination. — In some cases no evidence of 
lesion can be discovered to account for the disease, unless pos- 
sibly it might be an increased fullness of the vessels of the 
brain, and prominence of the puncta-vasculosa when incised*. 
In a majority of cases, however, there is extravasation of 
blood, sometimes to an extent not greater than the size of a 
pea or cherry, but occasionally as much as one or two ounces. 
In other cases, a portion of the brain seems to be softened, 
and having in most cases a well defined, reddish tint, which is 
said to be produced by iu filtration of blood. The fluid in the 
ventricles and cavity of the arachnoid is sometimes increased, 
sometimes diminished, and seems to bear no relation to the 
disease except in cases dying during reaction, when it is 
almost always increased, and presents evidence of inflamma- 
tory action. 

Treatment. — As in some cases there are premonitory symp- 
toms, we may first consider the prophylactic treatment of the 
disease. I have already noticed the fact that apoplexy occurs 
equally in stout fleshy persons, and in those of a spare habit, 
but we now wish to know whether there is determination to 
the brain, congestion, or feeble circulation. In the first case 
the face is flushed, exhibits the color of arterial blood, the 
head is hot, the pulsation of the carotids very manifest, and 
the pulse full and hard. To relieve this condition, we would 
give the patient a hydragogue cathartic, as, Compound Pow- 
der of Jalap and Bi-tartrate of Potassa, and follow it with a 
saline diuretic and Tincture of Gelseminum in small doses. 
If there is pain in the head, with feeling of tension, cups to 
nape of the neck and spine will answer a good purpose. The 
patient should be put upon a light diet, and though out-door 
exercise is beneficial, yet all causes of excitement should be 
avoided. By these means we may expect to overcome the 
predisposition to the disease, when by living a temperate life 
there will be no further danger. If there is a pufiiness of the 
countenance, with a purplish or lead- color, cold sweat stand- 
ing in drops on the forehead, with giddiness, stupor, and dis- 
position to syncope, we have a case of congestion. Here we 
would resort to the hot stimulant foot bath, dry cups to the 
neck and spine, and a cathartic of, #, Podophyllin, gr. v; 



426 The Eclectic Practice of Medicine. 

Jalap, gr. xx ; Ginger, 3j ; M., and divide in from five to eight 
powders, according to the case, and give one every four to six 
hours until they operate. The patient should he kept in the 
recumbent position until the symptoms pass off, and for some 
days should have a combination of Quinia, Hydrastin, Extract 
of Nux Vomica and Podophyllin, as heretofore recommended. 
If the cerebral circulation is feeble, as we will see -from the 
pallid face, sunken eyes, dilatation of the pupil, ringing in 
the ears, disordered vision, etc., we would use tonics and 
stimulants, with Phosphoric Acid or the hypophosphites and 
nutritious food, to overcome the difficulty. In this case a 
total cessation of mental labor should be required, and all 
unnatural excitement avoided. 

During the attack I would direct stimulant applications to 
the lower extremities, dry cups to the spine, and if the face 
was turgid and red, wet cups to the neck. In this case, if 
the patient could swallow, I would give a pill of, #, Croton 
Oil, gtt. j ; Podophyllin, gr. j ; with one or two grains of 
Capsicum; and to assist its action an enema of Compound 
Powder of Jalap, 3ss, in a pint of warm water. If the head 
is hot, cold applications should be employed, or sponging 
with warm water and fanning. If the face was dusky, lurid, 
or purple, with cold, clammy perspiration on the forehead, I 
should direct wet cups to the entire length of the spine, fol- 
lowed by a sinapism, and cloths wrung out of a hot decoction 
of Mustard and Capsicum, to the extremities and bowels. 
Internally, the cathartic and enema above named may be 
used, and a stimulant, as Ammonia, Chloroform, or Compound 
Tincture of Oil of Cajeput, given freely. "When it results in 
persons of feeble circulation, the countenance being pallid or 
cadaverous, the e}^es sunken and pupils dilated, we would 
employ the most powerful stimulants externally, and the 
Compound Tincture of Cajeput internally, and as soon as 
consciousness commenced to return, put the patient on the use 
of Quinia, and gradually adopt the treatment heretofore 
named as prophylactic. 

As soon as possible after the attack the patient should be 
placed on a lounge or hard bed, in the center of a cool room. 
If possible, he should be kept on his side, with the face turned 
downward, so as to avoid the falling back of the .tongue, 
which I have no doubt so impairs respiration when the 
patient is lying on his back as to lead to a fatal result by slow 



Coup de Soliel. 427 

asphyxia, in cases which would otherwise have recovered. If 
the attack has been preceded by a hearty meal, or as in some 
cases by the taking of two or three times as much ingesta as 
the stomach is capable of appropriating, the stomach should 
be evacuated, with a Salt and Mustard emetic, preparatory to 
other treatment. 

If the attack has lasted beyond twenty-four hours, we may 
be satisfied that there is effusion, or that the cerebral hemor- 
rhage has been considerable. In these cases we would keep 
the bowels open, the skin moist and active, by the use of 
baths and the internal administration of diaphoretics, and 
secretion from the kidneys by the use of an alkaline diuretic. 
As a diaphoretic, I prefer the Essl. Tincture of Asclepias and 
Carbonate of Ammonia, and as a diuretic a solution of Ace- 
tate of Potassa. "When the circulation seems feeble, I believe 
it to be good practice to give the patient Quinia and Hydras- 
tin pretty freely, and in some cases a small quantity of 
stimulants is advantageous. 



COUP DE SOLIEL. 

Sun-stroke is such a common affection in this country, 
during the heat of summer, that we would expect to find it 
described in all works on practice, and frequently mentioned 
in periodicals. But strange to say, with the exception of two 
or three notices in foreign journals, which were republished 
in this country, the literature of the disease is confined solely 
to the daily papers which report the attacks of the disease 
and the deaths from it, as they would the falling of a man 
from a house, or his being shot in a street rencontre. 

The predisposing causes of the disease are such as enfeeble 
the frame and oppress the nervous system ; thus, we find it 
to occur most frequently after slight attacks of sickness, after 
severe physical exertion, and especially after exhaustion of 
the nervous system. Exposure to the rays of the sun, the 
temperature being from 90° to 100° in the shade, is the direct 
cause; and though in a majority of cases this exposure has 
been prolonged for hours, and day after day, in others but very 
few minutes are necessary for its production. 

As regards the pathology of sun-stroke, there is great dis- 
crepancy of opinion. Br. Dunglison regards it as an inflam- 



428 The Eclectic Practice of Medicine. 

mation of the brain or its meninges, others as an exhaustion 
or paralysis of the brain, others as a species of apoplexy, and 
others again as an apoplexy of the lungs. Dr. Pirrie remarks 
that "The mode of death in all but the rapid form, is evi- 
dently by apnoea, or at all events the symptoms of apnoea 
plainly predominate, and hence the name " heat asphyxia " 
given by some to this most alarming disease. The symptoms 
are distinctly those of that mode of dying in which death 
commences in the lungs ; but by what means the circulation 
begins to be arrested in the lungs — or, in other words, the 
manner in which high temperature operates in causing stag- 
nation of blood in the lungs — whether it be by giving rise to 
immense engorgement, or by causing imperfect arterialization 
of the blood — I do not consider myself qualified to give an 
opinion." It is my opinion that the action of heat on the 
brain is productive of cerebral syncope or partial paralysis of 
the nervous system, and that this by enfeebling the action of 
the heart and lungs, causes the engorgement of the latter and 
difficulty of respiration. 

Symptoms. — Most generally the patient has a premonition 
of the approaching sun-stroke, in a feeling of giddiness, with 
heaviness of the head, and feeling of tension as if it was 
bound round with iron, ringing in the ears, and disordered 
vision. The feeling of faintness and difficult respiration is 
sometimes so marked, that with the other symptoms the 
patient is compelled to seek shelter, or to sit or lie down. 
Probably before reaching the desired place he suddenly loses 
consciousness and falls to the ground. In other cases the pre- 
monitory symptoms seem to be of brief duration, or to have 
been entirely absent. The patient suddenly falls unconscious, 
while walking along the street, or attending to his business, 
and though there may be brief returns of consciousness, it is 
not complete for several hours, or the patient may die in a 
short time after the attack. Irritability of the bladder is said 
to be one of the most certain symptoms of an attack. 
•: If we examine a person suffering from sun- stroke, we will 
find the pulse frequent, sharp and irregular, sometimes soft, 
small, and easily compressed, the respiration is laborious, but 
not stertorous, in most cases the face is turgid but dusky, and 
the head hot. In some cases there is nausea and vomiting 
or retching, and occasionally involuntary discharges of urine 
and faeces. These symptoms may continue to increase, the 



Coup de Soliel. 429 

disease terminating fatally in from one to two hours, or they 
may gradually pass off, the patient regaining consciousness, 
but being excessively feeble. It usually requires some time 
for the person to regain his strength — the head feeling heavy 
and dizzy, with disposition to syncope on slight mental or 
physical exertion. Frequently an irritability of the stomach, 
with diarrhoea, will remain and prove very intractable. 

Diagnosis. — Usually we have but little trouble in making a 
diagnosis, the occurrence of the disease while exposed to the 
heat of the sun, the difficult respiration, sharp and frequent 
pulse, and heat and redness of the face and scalp, are gen- 
erally sufficient. It might be more readily mistaken for 
apoplexy than any other affection ; yet if we recollect that 
in this the pulse is slow and full, respiration slow and ster- 
torous, and complete loss of consciousness, we would not be 
likely to make the mistake. 

Prognosis. — The prognosis is favorable in a majority of 
cases, though in some the patient is dying from the first of 
the attack. If the pulse is regular, and respiration sufficiently 
free to aerate the blood, there is usually but little danger. If 
however, the pulse is rapid, irregular, very small, the coun- 
tenance has a dusky, leaden hue, the lips purple or livid with 
labored respiration, the patient will, in all probability die. 

Post-Mortem Examination. — Mr. Longman remarks : "That 
in all the cases much the same appearances were presented, 
as if the patient had died asphyxiated from some cause. 
Thus, excessive engorgement of the lungs, amounting gener- 
ally to complete obstruction of the pulmonary circulation, 
and, in parts, having all the appearance of true interstitial 
apoplexy, were most remarkable. The cerebral congestion, 
less marked in character and less constant in amount, seemed 
to me, secondary to the failure of the due performance of the 
act of respiration, and perhaps resulted from loss of tone in 
the vessels, and from enfeebled action of the heart, owing 
to the imperfectly oxygenized blood it was receiving. " 

Treatment. — The patient should be removed to the shade 
as speedily as possible, and placed in a recumbent position, 
care being taken that he is not crowded on by spectators, but 
that a free circulation of air is allowed. Cold water should 
then be freely applied to the head, the extremities rubbed 
with stimulants, and if possible a sinapism applied to the 
chest and epigastrium. Diffusible stimulants ^may be applied 



430 The Eclectic Pkactice of Medicine. 

freely; I prefer the Compound Tincture of Cajeput or Tinc- 
ture of Xanthoxylum, Tincture of Camphor, or when these 
can not be obtained, Brandy and Capsicum or Ginger. In 
many cases, a brisk purgative, as Croton Oil and Podophyllin, 
will answer a good purpose; but frequently there is such irri- 
tation of the gastro-intestinal mucous membrane as to prevent 
their administration. Ten grains of Quinia, with an ounce of 
Brandy, is a most excellent remedy to overcome the nervous 
depression, and may be used in place of the medicines first 
named. If the face is much flushed, the head hot, and throb- 
bing of the carotids, wet cups applied to the neck and spine 
will be useful, and may be followed by a sinapism if there 
seems to be need of further derivation. 

When the patient commences to recover he should be kept 
very quiet and free from excitement, and should not be moved 
until late in the day, A small quantity of some diffusible 
stimulant, with occasionally a grain of Quinia an hour, is all 
that the patient needs. For two or three days, or until the 
effect has passed off, the patient should be quiet and careful 
in his diet. The bowels should be kept regular, and the skin 
and kidneys acting. A gentle bitter tonic, as the Nux Vom- 
ica pill heretofore named, will facilitate convalescence. If 
there is headache, with irritation of the stomach, a solution of 
Acetate of Potassa will usually be the best remedy, as these 
symptoms most usually depend upon diminished secretion of 
urine. 



EPILEPSY. 

Epilepsy is one of the most serious of the diseases of the 
nervous system, not because of its fatality, for it runs a very 
chronic course, but because there is no tendency to spontane- 
ous arrest, and medicine has heretofore had very little influ- 
ence upon it. One of the most distressing features of the 
disease is, that it gradually impairs the mind, until the person, 
once bright and of sound mind, becomes a driveling idiot or a 
raving maniac. The disease usually commences in childhood, 
most frequently between the ages of six and twelve. 

The causes of epilepsy are various, and not very well 
understood. They may be divided into intrinsic and extrin- 
sic, in the first case existing in the cerebro-spinal nervous 
centers, or their immediate surroundings, and in the second 



Epilepsy. 431 

existing at a distance, and affecting the spinal cord through 
the nerves. Of the first, we may instance inflammation and 
determination of blood to the cerebro-spinal centers, disease 
of the meninges and of the bowels, and injuries of the bones, 
giving rise to compression; or continued irritation, as by the 
presence of a spicula pressing the nerve-substance. Derange- 
ments of the blood may sometimes give rise to epilepsy, as in 
the retention of the solids of the urine and other changes 
that we are not cognizant of. By an extrinsic cause, we 
understand one in which the irritation being set up at a dis- 
tance is propagated along the nerve trunks to the spinal 
cord, where, setting up an irritation, it manifests itself 
through the excito-motory system of nerves. The most 
simple instance of this action is witnessed in the case of 
cramps of the muscles of the extremities from irritation of 
the intestinal canal, as in cholera morbus, and in the case of 
infantile convulsions from teething or from gastro-intestinal 
irritation. Epilepsy may in this way arise from irritation of 
the stomach from crude indigestible food, from worms, from 
irritation of the bowels, the kidneys, bladder, or genital 
organs. The cause being sufficient to set the disease going, 
may disappear entirely in a few days or weeks, and yet the 
epileptic attacks continue. It would seem that when this 
abnormal action is once set up, the tendency to its continuance 
is the same as in healthy functions; but why this is we know 
not, and neither can we give any probable theory. 

As regards the pathology of epilepsy, we are much in the 
dark. In some cases it would seem to be dependent on a too 
free circulation of blood in the nervous centers — determination 
of blood; in other cases upon a sluggish circulation — conges- 
tion ; and in still others, upon some defect in nutrition. There 
are cases in which it is very manifest that the condition of 
the blood is the exciting cause of the epileptiform seizure, 
though we must still imagine an unnatural irritability of the 
nerve centres to be so impressed. Thus, I have seen cases in 
which every convulsion was preceded by deficient secretion of 
urine ; and so long as this secretion could be maintained in the 
normal condition, so long would the patient be free from its 
seizure. Cases in which the disease is dependent upon the 
amount and character of the menstrual discharge have come 
under the notice of almost every one. Experience, however, 
has proven to me, that epilepsy is eminently a disease of 



432 The Eclectic Practice of Medicine. 

debility of the nervous system, even in cases in which there 
seems to be the most evident symptoms of irritation and 
determination of blood. 

Dr. Radcliffe has written a most interesting paper on the 
pathology of convulsions, and draws the following conclu- 
sions : " 1st. The epileptic and epileptiform paroxysm is not 
unfrequently preceded by signs of defective respiration. 2d. 
It is usually accompanied by a state of unmistakable suffoca- 
tion. 3d. The condition of respiration during convulsion is 
one which supports the notion that the convulsion is con- 
nected with depressed and not with exalted vital action. 4th. 
In the chronic form of convulsive disorders, the inter-parox- 
ysmal condition is usually marked by evident signs of feeble 
circulation. 5th. The epileptic and epileptiform paroxysm 
is usually, if not invariably preceded by signs of failure in 
the circulation. 6th. In the fully developed paroxysm, the 
pulse is sometimes aroused to a considerable degree of activ- 
ity, not because the arteries are receiving a largely increased 
supply of red blood, but because they are then laboring under 
a load of black blood, as they are found to labor during suffo- 
cation. 7th. Convulsion is never co-incident with a state of 
active febrile excitement of the circulation. 8th. Epilepti- 
form convulsion is a direct consequence of sudden and copi- 
ous loss of blood. 9th. The condition of the circulation 
during convulsion is one which supports the notion that the 
convulsion is connected with depressed and not with exalted 
vital action." ^ 

It is of but little use to try to study the original cause in 
many cases of epilepsy, for as has been before remarked, it has 
possibly passed away months before our examination. There 
is always, however, an exciting cause, which it is necessary to 
determine, if possible, as upon its removal, the success of our 
treatment will in great measure depend. I have known it 
to be a failure of excretion, an imperfection in digestion, 
derangement of the menstrual function, excessive mental 
emotion, and not unfrequently excessive sexual excitement. 

Symptoms. — In some cases there are brief, premonitory 
symptoms of the approaching seizure, and rarely, the patient 
has notice of it for hours. The sensations differ iu different 
cases, sometimes a sense of weight and oppression in the 
head, with giddiness and loss of voluntary power; in others, 
a coldness passing from the feet upwards, and terminating in 



Epilepsy. 433 

the epileptic seizure when it reaches the head. In the more 
protracted cases there is usually a marked dullness and heb- 
etude, noticed by the friends, and the patient feels a loss of 
consciousness that is very unpleasant. 

In an attack of epilepsy the patient becomes suddenly 
unconscious and falls to the floor, or wherever he may be sit- 
uate. Involuntary movement from spasmodic contraction and 
relaxation is characteristic of the disease, and may be very 
intense or mild. If severe, the limbs are thrown in various 
positions, the trunk contorted, and the features remarkably 
changed. First one group of muscles contract, and then 
another, so that parts are kept in constant movement. The 
lower jaw and tongue being also affected, we find that usually 
the latter organ is severely bitten if means are not taken to 
avoid it. The patient usually froths at the mouth; respiration 
is normal in frequency, and the pulse but little changed, 
except that it is smaller and feebler. The countenance is not 
only distorted by the convulsion, but in some cases is turgid 
and purplish, or almost black. Frequently the urine, and 
sometimes the fseces, are passed involuntarily during its con- 
tinuance. 

The duration of the epileptic seizure is very variable, some- 
times lasting but a few seconds, and at others for fifteen or 
twenty minutes. The patient may have but one attack at a 
time, or they may succeed one another at short intervals until 
quite a large number has passed. "When the attack ceases, 
the patient becomes completely relaxed, and usually falls into 
a deep, comatose sleep, from which it is almost impossible to 
arouse him, for an hour or two. The frequency of their 
recurrence varies in different cases ; in some they do not 
appear oftener than once a month, or even less frequently; in 
others, every week, or almost every day. Sometimes they are 
so distinctly periodic that the return can be closely calculated, 
but at others they are very erratic in their course. In many 
cases there are slight seizures during the intervals between the 
principal attacks ; in these the patient seems to lose conscious- 
ness for but a moment, and stares vacantly at persons pre- 
sent ; passing off, he has no recollection of it, nor of the epileptic 
attack. 

Diagnosis. — We diagnose epilepsy from apoplexy by the 
fact that in the first there is continual spasmodic action, while 
in the last there is not the slightest motion ; in the one there 
28 



434 The Eclectic Practice of Medicine. 

is frothing at the mouth, in the other it occurs but rarely; in 
apoplexy the respiration is slow and stertorous, and the pulse 
full and slow, while in epilepsy respiration is of usual frequency 
without stertor, and the pulse is small and frequent. "We 
diagnose it from hysteria by the previous history of the case, 
and by the fact that we are able to determine that there is not 
complete loss of consciousness in the last case. 

Prognosis. — So far as regards the cure of the disease, the 
prognosis is unfavorable, unless the means here recommended 
prove more serviceable than those heretofore used. But as 
before remarked, it runs a course of years, and the patient 
dies finally of some other affection in a great many cases. 

Post-Mortem Examination. — In a majority of cases, the 
scalpel reveals no lesion to account for the severe disturbance 
of the system during life, and what lesions are found generally 
have no relation to the epileptic affection. In some cases the 
evidence of slow inflammatory action is found in the brain or 
spinal cord, or in rare cases, a morbid growth in the nervous 
substance, or from the meninges or bones, is observed, and in 
others a change of structure, usually softening, has occurred. 
These, however, form but a small fraction of the cases. In 
other instances, some organ, as the stomach, kidneys, 
uterus, etc., is found diseased, and as the epilepsy made its 
first appearance with the symptoms of these diseases, we have 
good reasons to believe that they acted as exciting causes. 

Treatment. — The treatment in these cases is of two kinds : 
that for the arrest of the paroxysm, and that for the radical 
cure of the disease. If called to see a person suffering from 
an attack of epilepsy, we would place the patient in such a 
position that he would not be likely to injure himself, and if 
the convulsive action was severe, get a friend to hold a cork or 
piece of soft wood between the teeth to prevent luting the 
tongue. Usually this is all that is necessary, except in cases 
where the patient has a succession of attacks. In these cases, 
as soon as the first paroxysm commenced passing off, we might 
administer the Compound Tincture of Lobelia and Capsicum, 
in half-teaspoonful doses every Sive or ten minutes, until nau- 
sea is induced, which in a large majority of cases will prevent 
a return of the convulsion; or we may use the Tincture of 
Gelseminum for the same purpose, giving it in doses of from 
ten to twenty drops, or even half a drachm of the common 
tincture every ten or fifteen minutes, until the full relaxant 



Epilepsy. 435 

influence of the remedy was produced. A combination of 
Sulphuric ^Ether, Liquor Ammonia, and Tincture of Assafce- 
tida may be used for the same purpose, but is not as efficient 
as the preceding measures. If need be, stimulant applications 
may be made to the lower extremities and to the spine, but 
usually this is not necessary. 

As regards a radical cure we may attempt it in all cases in 
which there is no structural lesion of the spinal cord or brain, 
or their enclosures, to account for the disease ; if there is, the 
case becomes one for the surgeon rather than the physician, 
though operations thus far have proven very unsuccessful. If 
we can detect any lesion of function, especially if it seems to 
bear a relation to the epileptic seizure, we would employ 
remedies for its removal. Thus, in rare cases, a cure will 
result from the removal of worms, and relief of irritation 
of the intestinal canal ; from the relief of menstrual irregu- 
larity ; by establishing and maintaining free secretion from 
the kidneys, when functional lesion of these organs has been 
prominent, etc. In some cases, the disease appears to be 
dependent upon spinal irritation and determination of blood 
and occasionally a cure may be effected by the use of the 
irritating plaster to the spine, the administration of Tinc- 
ture of Gelseminum, and the use of those other measures 
recommended under the head of spinal irritation. Belladonna, 
Ergot and Nux Vomica may be used when there seems to be 
feeble circulation in the nervous substance and tendency to 
congestion, manifested by symptoms of paralysis, or a feeling 
of deadness, coldness, or of tingling, as if the part was asleep. 

In a large majority of cases, however, there is no lesion 
that would seem sufficient to occasion the epileptic seizure ; 
and even when there is, and we have removed it, and 
restored all the functions of the system, the nervous disease 
will still continue. Here, our treatment will be, to a great 
extent, empirical ; it is true, we correct all lesions of function, 
and get the system in as healthy a condition as possible, but 
after this we give remedies simply because they have proven 
efficient in other cases. I have employed the Bromide of 
Ammonium in my practice, with the most marked success, 
sometimes using it alone, and at others in combination with 
other remedies ; I prescribe it in the proportion of half an 
ounce of the salt, to four ounces of water, of which the dose 
is a teaspoonful four or five times a day. If there is feeble- 



436 The Eclectic Practice of Medicine. 

ness of the system, and especially of the organs of digestion, 
the ISTux Vomica pill, heretofore named, proves useful. Fre- 
quently I associate with it, #, Tincture of Lobelia, Tincture 
of Valerian, aa, f 3 j ; Tincture of Gelseminum, f^ss; Simple 
Syrup, f3jss; M., and give in teaspoonful doses every four 
hours, alternating with the other. Some most persistent cases 
have yielded to this treatment, and I am in hopes that it will 
prove curative in many of these distressing cases. 

All undue excitement must be avoided in epilepsy, the 
sufferer leading the most regular life. Some employment 
should be furnished that would amuse the mind, and keep it 
normally active, but much mental exertion is injurious; novel 
reading, or anything in which the mind becomes deeply 
absorbed, proves hurtful. Above all things else, excessive 
sexual excitement is most injurious, either as solitary vice or 
too frequent connection, and it will become the practitioner's 
duty to examine into the case with reference to this matter, 
and give the necessary advice. 



CONVULSIONS. 

Convulsions occur far more frequently during childhood 
than after puberty, though they may be occasionally noticed 
at all ages. The causes giving rise to them are various. 
Sometimes they are produced by disease of the brain and 
spinal cord, as in determination, inflammation, and some 
obscure structural lesions ; at others they arise from an exter- 
nal irritation, it being transmitted to the spinal cord, and 
giving rise to excited reflex action. According to Dr. Mar- 
shall Hall, convulsions are dependent upon irritation of the 
true spinal system, and though this occurs in some cases from 
causes acting directly upon the nervous system, it more fre- 
quently depends upon an irritation of some distant part, 
transmitted to the spinal cord through the nerves. Thus, we 
find convulsions arising in this way during dentition, from 
crude or acrid ingesta, from irritation of the stomach or 
bowels, from the irritation produced by worms, and from 
inflammation of internal organs, or disease of the surface, 
attended with great irritation and pain. 

Symptoms. — If convulsions occur during disease, they are 
generally preceded by tolerably well marked symptoms, by 



Convulsions. 437 

which the close observer may anticipate their approach ; and 
though not always constant it is well to give them due consid- 
eration. The most marked of these, is a sudden, jerking, 
involuntary movement of the extremities, and quick, grasp- 
ing movement of the hands. This will be observed as well 
when the child sleeps as when awake, and is sometimes 
increased by motion. Usually the child sleeps with its eyes 
partly open, and we observe that the globe of the eye is drawn 
upward and rolled about, and this involuntary movement of 
the eye may be frequently noticed when awake. "With these 
symptoms there may be excitement of the nervous system, 
manifested by restlessness, fits of crying in children, and 
sleeplessness ; or we may have the reverse, the patient being 
dull, impassible and somnolent. 

The attack is always sudden, the patient losing conscious- 
ness, and being to a great extent insensible. The convulsion 
is usually very marked, but in some cases, we will find it 
slight or entirely absent, the patient being rigid and remain- 
ing in one position. Eespiration is labored, in many cases 
very markedly so, and in these the countenance is turgid and 
purple, and the features much distorted. The pulse is very 
frequent and small, or it is soft, feeble and small, and but little 
increased in frequency. In the severer cases, deglutition is 
almost impossible, and from the falling backward of the 
tongue respiration is snoring. These symptoms may continue 
for a moment or two to fifteen minutes or half an hour, in 
the milder cases terminating in a return of consciousness, but 
the severer in a deep sopor, from which the patient can not 
be aroused. One convulsion may terminate the attack, but 
in many cases one succeeds another for from one to twenty- 
four hours. The interval between the spasms is frequently 
marked by nothing more than a relaxation of the entire 
system, and a restoration of the power of deglutition, the 
patient being in a semi- comatose condition, and totally uncon- 
cious. Children having convulsions once, are usually more 
liable to them than others, and they will frequently come on 
from slight causes. 

Diagnosis. — The diagnosis of convulsions is very easy, there 
being no possible chance of mistaking the symptoms. The 
sudden loss of consciousness, convulsive movement, difficult 
respiration, and frequent, small pulse, can not be confounded 
with any other disease. It is true that we can not distinguish 



438 The Eclectic Practice of Medicine. 

between simple convulsions and epilepsy, except by the lapse 
of time. 

Prognosis. — The prognosis is usually favorable, though it 
is very difficult in some cases to arrest the convulsive action. 
Occasionally cases will be seen that will prove fatal in spite 
of treatment. 

Post-Mortem Examination. — The scalpel reveals no con- 
stant lesion to account for the symptoms. When there has 
been determination to or inflammation of the brain, we of 
course will find the evidence of these lesions. But when the 
disease has arisen from an extrinsic irritation, there is not the 
slightest evidence of disease of the nerves. 

Treatment. — Our primary object is to arrest the spasmodic 
movement which is so alarming to the friends, and, no matter 
how often seen, to some extent so to the practitioner. Calmness 
and decision are very important requisites in this case, as all 
around the patient is excitement, and a hundred expedients 
to benefit the sufferer are proposed. Usually we would give 
our patient the Compound Tincture of Lobelia and Capsicum, 
in doses of a teaspoonful every iive minutes to an adult, and 
one-fourth of a teaspoonful as frequently to a child. "We can 
usually administer this during the paroxysm by carefully 
pouring it into the mouth, and allowing it to pass down the 
throat gradually. This should be continued until the con- 
vulsion passes off, nausea being generally induced; or, if we 
have reason to suspect crude ingesta, we should carry it to 
free emesis, or instead give a sufficient quantity of Ipecac to 
evacuate the stomach. If the medicine can not be given by 
mouth, we would use it as an enema, combining two or three 
times the quantity with the necessary amount of water, and 
repeating it as occasion requires. The Tincture of Gelsemi- 
num is the next and most efficient agent, and may be given 
in doses of from half to one teaspoonful of the common tinc- 
ture to an adult, or from ten to fifteen drops to a child two 
years old. It may be repeated at intervals of ten or fifteen 
minutes, or as occasion requires. Tincture of Assafoetida or 
Sulphuric JEther, sometimes answer a good purpose, and 
occasionally Valerian may be added to the combination for its 
arrest. These remedies should not only be given during the 
convulsion, but afterwards to prevent its recurrence. 

Bathing the feet in hot Mustard water for ten or fifteen 
minutes, or the use of the hot sitz bath, is frequently attended 



Tetanus. 439 

with benefit. Occasionally sinapisms to the feet or ankles, 
are applied, or to the bowels if there seems to be heat or irri- 
tation. If the face is flushed, and the head hot, we would 
use cold applications, and in some cases cups to the neck and 
spine. There are cases, as for instance when the skin was 
hot and burning, that I would prefer the wet sheet pack to 
all other medication. 

If the symptoms of convulsions are noticed, we may almost 
always prevent their occurrence by the administration of 
small doses of Tincture of Gelseminum. So certain is it in 
its action in doses of from six to ten drops every half hour, 
hour, or two hours, to a child two years old, that I leave it in 
cases of threatened convulsions with the greatest certainty 
that it will prevent their occurrence; and in families in my 
practice where there is a tendency to convulsions during 
childhood, the remedy is kept constantly on hand; not only 
is it a good prophylactic before the convulsion, but it is also 
one of our best remedies to prevent their recurrence when 
once arrested. Just as soon, however, as the first convulsion 
has passed off, we endeavor to learn its cause, so that by its 
removal we may avoid any danger of its recurrence. Thus, 
if from crude ingesta, we give an emetic; if from irritation of 
the bowels, we use the appropriate means to relieve it; and if 
from arrested secretions, these should be reestablished. 



TETAKUS. 

Tetanus or lock-jaw is the most fearful of the diseases of 
the nervous sj'stem, not only from its intractability to medi- 
cine, but from the severe and continued suffering that attends 
it. It most usually arises from injury, though in some cases 
it is idiopathic. The smallest injury is as likely to cause the 
disease as the largest; and it is more frequent, the further the 
injury is from the spinal cord. Small punctured wounds seem 
to be the most dangerous, as from running a nail, thorn, piece 
of glass or needle, in the foot or hand. It must not be sup- 
posed that these are the only injuries followed by tetanus, as 
it occurs after amputations and other operations, from frac- 
tures, dislocations, and other injuries. "Where idiopathic, it 
seems to be partially dependent upon a vitiation of the blood, 
and partly upon an extremely excitable condition of the spinal 



440 The Eclectic Practice of Medicine. 

cord. We do not know why a distant irritation, as of a wound 
of the foot, for instance, should produce an irritation of the 
spinal cord, and dissection does not assist the explanation. 
But that there is an extreme erethism and excitement of the 
true spinal cord, prolonged until all vitality is exhausted, can 
not be doubted. This excitement and its effects are produced 
by poisonous doses of Strychnia, and yet though the .-convul- 
sion may continue for hours or days, there is no evidence of 
physical lesion. 

Symptoms. — When tetanus results from injury, a week or 
more frequently intervenes between the occurrence of the acci- 
dent and the attack. During this time there is no evidence of 
the disturbance, and the wound frequently heals up kindly 
previous to the commencement of the disease. In some cases 
there will be a sense of soreness and stiffness, extending from 
the injured part up to the spinal cord, and more or less of it 
may be felt in the back. The approach of the disease is man- 
ifested by a stiffness of the muscles of the neck, and of the 
mouth and throat; these increasing, he finds it impossible to 
turn his head without turning the body, and he can not open 
the mouth or swallow without pain. Soon the disease clevel- 
opes itself in the form of an excessive aching contraction of 
various groups of muscles, the pain seeming to shoot through 
the body to the part affected; and these are accompanied with 
a sensation of almost unendurable tension and pressure. This 
lasts for a few minutes, and then gradually ceases, but we find 
by examination there is still an unnatural rigidity and stiffness 
of the body, it not being relaxed after the spasm has passed 
off, as in other convulsive affections. The intervals of rest 
may at first be one or two hours, but they are gradually 
decreased, until at last there is but a minute or two, or they 
succeed each other like so many electric shocks. The breath- 
ing is quick and laborious, and the pulse, though calm and less 
hurried, small and irregular. The face is sometimes pale, but 
oftener flushed; the whole countenance evinces the most 
marked signs of deep distress, and swallowing is pertina- 
ciously abstained from, as accompanied with great difficulty 
and often producing a sudden renewal of the paroxysms. 
The last stage of the disease is truly pitiable, the spasms 
return every minute, and scarcely allow a moment's remis- 
sion. In some cases the posterior muscles are principally 
involvedj and in the latter stage of the disease the spine will 



Tetanus. 441 

be so recurved that the patient will rest on his head and heels. 
In some cases the spasms become so severe that it is with the 
greatest difficulty the patient can be kept in bed; and cases 
are reported in which fracture of the bones occurred from the 
intense muscular contraction. The muscles of the inferior 
maxillary are so involved that the mouth is frequently opened 
and closed with great force, and the tongue, being protruded 
by spasmodic action, is often horribly mangled and bruised. 
The countenance is very markedly changed, the eyes being 
watery and fixed, the nostrils' drawn upwards, and the cheeks 
backward to the ears, giving rise to that peculiar expression 
termed risus sardonicus. These symptoms continuing, gradu- 
ally exhaust the patient, or a general convulsion occurs and 
he suddenly sinks under it. 

Diagnosis. — Stiffness of the muscles of the neck, and of the 
jaw, with difficult deglutition, should always occasion alarm, 
when unaccompanied with disease of the throat, or cold, and 
especially when occurring after an injury. Proper treatment 
at this time, I am satisfied, will avert the disease, and hence 
the importance of recognizing the symptoms. When the dis- 
ease is fully developed, the symptoms can not be mistaken, 
the continued recurrence of painful spasms, the rigidity of the 
body, with perfect consciousness, are symptoms that do not 
occur in any other affection. 

Prognosis. — This is undoubtedly one of the most fatal dis- 
eases we are called to treat, and though some may recover, 
a large majority will die. If taken at the commencement we 
may, as before remarked, control the disease, but after it has 
become severe, the most we can hope for is, to modify the 
convulsive action, and support the strength of the patient, so 
that it may wear itself out. 

Post-Mortem Examination. — Various lesions are observed, 
the result of the long-continued and excessive muscular con- 
traction, and the consequent derangement of the circulation, 
but they bear no relation to the disease other than as effects. 
On examination of the spinal cord and base of the brain, the 
membranes and even the nervous tissue is found injected, and 
there is also evidence in the deposit of coagulable lymph, of a 
low form of inflammation. In some cases these appearances 
are well marked, but in others very obscure. 

Treatment. — If called to a case presenting the forming 
symptoms of tetanus, I should immediately give an emetic of 



442 The Eclectic Practice of Medicine. 

the Compound Powder of Lobelia and Capsicum. Its action 
should be thorough, and continued until it produces complete 
relaxation, and perspiration. This should be followed by 
Tincture of Gelseminum, in doses of from twenty drops to one 
fluid drachm, every hour or two, or sufficiently often to con- 
trol the symptoms. . The bowels may be moved by the Com- 
pound Podophyllin pill, if deemed necessary; and if the 
patient is sleepless, a sufficient dose of Opium or Sulphate of 
Morphia, may be given to produce sleep: it will generally 
require two to five grains of the first, and from half to one 
grain of the second. I am satisfied that if any treatment will 
prove successful, this will, and if any one agent is more to be 
relied on than another, it is the Gelseminum. 

If the tetanus is the result of a wound or injury, it sometimes 
becomes necessary to make use of local implications. As a 
general rule, if it has been a punctured wound, as from a nail, 
thorn or piece of glass, and has closed up on the outside, it 
should be opened, and syringed with a saturated solution of 
Sesqui-carbonate of Potassa; if irritable and tender to the 
touch, secreting a sanious pus, it should be freely cauterized 
with Chloride of Zinc, and a soothing poultice, as of Poppy- 
heads or Stramonium applied. Whatever will quiet irritation 
most speedily should be applied. In some cases, the injury 
being severe, amputation has been resorted to with reported 
success, but I am inclined to doubt it, as all the cases that have 
come to my knowledge have died. 

"When the disease is fully established, we may attempt to 
control the symptoms by the treatment above named, and if 
the case is mild it may succeed. If it does not arrest the 
spasms, or increase the interval between them, it should not 
be continued longer than twelve to twenty-four hours. Cups 
to the spine have been used with advantage, and if there was 
great difficulty of breathing from spasm of the diaphragm, 
they might be applied entirely around the margin of the false 
ribs. Opium and Chloroform seem now to be our principal 
remedies, as they give ease when all others fail; Opium may 
be given in doses of Hve grains, or Sulphate of Morphia in 
doses of one grain; Chloroform, however, answers a better 
purpose ; as by its continued use we can control the spasm 
and pain. Anaesthesia need not be deep, but should be so 
continuous as to prevent a return of the convulsion. 

The Woorara, used as an endermic injection has been recom- 



Hydrophobia. 443 

mended as an antidote, and though successful cases were 
reported, it is now believed to be entirely inefficient. Nico- 
tine has been used in Dublin with more marked success than 
has attended any other agent, and I will certainly try it, should 
I be so unfortunate as to have another case. It is given in 
doses of one drop in wine, and repeated as often as may be 
necessary to control the convulsion, and if need be the dose is 
increased to two drops, or if rejected by the stomach, it may 
be used as an enema. Cases are reported in which it is mani- 
fest that the remedy exerts a marked controlling power over 
the disease, which may be rendered curative with proper care. 
It must not be forgotten that the patient needs sustenance 
through this prolonged muscular action and pain. It should 
be given in the form of rich animal broths and milk, with 
a sufficient amount of brandy. If it can not be taken by 
the mouth on account of convulsive action, it should be used 
as an enema. 



HYDROPHOBIA. 

Rabies is a disease of great antiquity, and has been described 
by most writers on Medicine from the earliest ages. It has 
its origin in the canine and feline animals, but may be propa- 
gated to all genera and species. 

How the disease originates, or what is the character of the 
poison is beyond our knowledge. Some contend that from 
its first commencement it has been propagated by contagion, 
while others reason that the causes which produced the first 
case, may be again set in action and reproduce the disease. 
These suppose that protracted thirst or hunger, extreme heat, 
violent excitement or anger, the sexual heat, etc., variously 
associated, will develop the malady independently of conta- 
gion. 

When once developed it is transmitted from one animal to 
another and to the human family, by a specific animal poison 
found in the saliva, and which is usually introduced into the 
blood, through a wound made by the teeth; though like all 
other animal poisons, all that is necessary is, that it shall be 
brought in contact with an abraded surface. 

As regards the physical properties or character of this 
poison, nothing is known, and neither has it been determined 



444 The Eclectic Practice of Medicine. 

what part secretes the poison, further than that it is furnished 
by the glands connected with the mouth. Some writers con- 
tend that it is not a disease of the blood, and urge as evidence 
the long period that sometimes elapses from the inoculation 
before the disease is developed. 

They therefore urge that it must be the nervous system 
that is affected, the phenomena being those of a nervous 
malady of the most intense form. 

As regards the pathology of the disease, we may assume 
that the poison of rabies absorbed into the system, gives rise 
to a peculiar irritation of the nervous system, more especially 
marked in the true spinal system. The symptoms all point 
to the medulla oblongata and spinal cord as the seat of the 
disease, and the post-mortem examination shows these parts 
to have been subject to severe irritation and vascular excite- 
ment. 

The appearance of hydrophobia in the dog is indicated by 
a change in his disposition, usually exhibiting a marked 
antipathy to other animals, and rarely becoming attached to 
those to whom he was formerly indifferent. He seems also 
to have changed his habits, picking up straws, rags or any 
small objects, and licking cold surfaces, as stone, iron, etc. 
He becomes morose and sullen in his disposition, becomes 
lonely, has a haggard and suspicious look, and is constantly 
thirsty; respiration soon becomes difficult, and saliva flows 
from the mouth, and forms a viscid foam, and he shows great 
irritability and a disposition to snap at and bite other animals, 
though he may still obey the voice of his master. At last he 
becomes uncontrollable, and flies at every creature he meets, 
and having no fear, he is not intimidated by holding or 
striking at him with a whip or stick, but is rendered more 
savage. At no period is there any dread of water, but the 
animal still exhibits strong evidences of thirst, and runs to it 
with avidity, and all other animals, with sometimes the excep- 
tion of the horse, drink with ease. The disease having con- 
tinued for several days, the animal is at length exhausted, and 
dies in convulsions. 

Symptoms. — The period of incubation is seldom shorter than 
from thirty to forty days, or may be postponed from one to 
two years. The wound seems to heal as kindly as it does in 
other cases, and usually no unpleasant sensation is experienced 
in it. Sometimes there is a feeling of constriction in the cica- 



Hydrophobia. 445 

trix, or slight shooting pain, but we are inclined to attribute 
this, as well as the quick pulse and constitutional symptoms 
sometimes met with, to the effect on the mind of the patient, 
rather than to the influence of the poison. 

The invasion of the disease is usually marked by a recur- 
rence of pain at the seat of the injury, which shoots upwards 
in the course of the nerves, occasionally to the epigastrium 
or prsecordia. Not only is there pain, but the cicatrix becomes 
of a dark livid red, is irritable, tumid, and sometimes sur- 
rounded by small phlyctenule, containing a bluish fluid, or 
in rare cases the cicatrix opens and discharges a watery or 
icherous fluid. The patient is now very anxious and restless, 
and complains of drowsiness, chilliness, flushes of heat, and 
sense of constriction of the throat, and stiffness of the parts 
concerned in deglutition. The act of swallowing, especially 
fluids, is now attended with pain and distress, and by spas- 
modic action of the muscles engaged, so that frequently they 
are forcibly ejected from the mouth. The difliculty of swal- 
lowing rapidly increases, and the patient fears to make the 
attempt, and the sight of fluids occasions the most distressing 
spasms of the throat, followed by sobbing, tremor, forcible 
respiration and exhaustion. 

The sufferings now become intense; the mouth is dry, 
parched and clammy, a frothy saliva being secreted, and 
occasionally forcibly expelled during the paroxysms; the 
thirst is intense, though the sufferer is not only unable to take 
fluids, but the sight or sound of them gives rise to uncon- 
trollable convulsions; the countenance is haggard and anx- 
ious, the brow contracted, the eyes staring and wild, and 
startling, in their expression, and the angles of the mouth 
retracted ; respiration is hurried, laborious, and attended with 
dryness and constriction of the air passages ; and the sensi- 
bility becomes so exalted that the slightest touch, or a breath 
of cold air striking the surface of the body, will occasion a 
paroxysm. 

The mind of the sufferer is usually clear in the absence of 
the paroxysms, but when they are on, he has the rabid impulse 
of biting or tearing to pieces whatever comes in his way. 
These symptoms continuing, the patient becomes gradually 
exhausted, the pulse becomes small and feeble, respiration 
hurried and difficult, and he dies suddenly during a violent 
exacerbation. The attack may last from two days to a week, 



446 The Eclectic Practice of Medicine. 

or in some rare cases, the symptoms become ameliorated, and 
quietly wear themselves out in the course of two, three or 
four weeks. In these last cases, the patient rarely recovers 
completely, but has occasional slight returns of the original 
symptoms. 

Diagnosis. — Usually we have to take the patient's word as 
regards the rabidity of the animal inflicting the wound, when 
he applies for advice a short time after the accident. It is a 
good rule in these cases to always treat it as if it were the bite 
of a rabid animal, if the patient believes it, or if the evidence 
is in any respect in favor of that opinion. "When the disease 
has fully developed itself, there is no mistaking its character, 
the difficulty in deglutition, spasms of the throat, increased 
by attempting to swallow fluids, and the peculiarly wild and 
anxious appearance of the countenance are sufficient. 

Prognosis. — The prognosis is extremely unfavorable, but 
very few cases recovering. 

Post-Mortem Examination. — The fauces, pharynx and oeso- 
phagus are usually found to be injected and reddened,' and 
covered to a greater or less extent with lymph. The mucous 
membrane of the respiratory apparatus is affected in the same 
manner, showing evidence of determination of blood, though 
in this case the blood is dark-colored; the lungs are usually 
congested, and more or less frothy mucus is found in the 
bronchial tubes. The vessels of the brain and spinal cord are 
generally congested, and the sinuses especially are filled with 
black blood ; there is also, in many cases, effusion into the 
ventricles and sometimes into the cavity of the arachnoid. 
The condition of the spinal cord varies in different cases, but 
in all it manifests serious lesions, as we should suspect from 
the symptoms observed during life. 

Treatment. — Immediately on the receipt of the injury, it is 
recommended to wash the wound or wipe it dry, and suck it 
with the mouth for five or ten minutes. Or the part may be 
immediately excised, or a ligature applied between it and the 
trunk, if of one of the extremities, to prevent the poison 
from gaining entrance into the system ; this will be done 
before a physician can be seen. When the case presents itself 
to us, we may excise the part bitten, or apply a cup to it, 
draining it well, or we may cauterize it freely. I prefer the 
latter practice, and use a saturated solution of Chloride of 
Zinc, bringing it in contact with the whole abraded surface. 



Hydrophobia. 447 

A deep eschar is formed, which does not slough for several 
days, and when thrown off the wound suppurates freely. 
Three cases were thus treated hy me in 1857, that had heen 
bitten by a dog that commuuicated the poison to several 
animals which died of hydrophobia; the cauterization was 
very thorough and deep, and not more than half an hour 
after the injury ; not one of the cases had any symptoms 
of the disease. A fourth case occurred in 1859, and a fifth in 
1.862, which were treated in the same manner and with the 
same result, but in neither of these was the evidence positive 
that the dog inflicting the bite was rabid. No internal medi- 
cines was used in any case. 

We must not conclude that all persons who are bitten by 
an animal known to be rabid will have hydrophobia, as expe- 
rience has demonstrated that the reverse is the fact. Many 
times the bite is inflicted through the clothing, and the poi- 
sonous virus is likely to be rubbed off the teeth of the animal 
as they pass through. In other cases the flow of blood is so 
free as to wash the poison out. Thus Mr. J. Hunter gives a 
case in which twenty persons were bitten by the same dog, 
and but one was affected by the disease. And Bennett states 
that at Sanlis a dog bit fifteen persons, three of whom died of 
hydrophobia. M. Trollet reports seventeen bitten by a wolf, 
with ten deaths, and twenty-three by a she wolf, with thirteen 
deaths, and in most of these precautions were used to prevent 
infection. 

When hydrophobia is fully developed, we are at a loss how 
to treat the patient; some writers have recommended the 
employment of Lobelia to keep up continuous nausea; others 
to give Scutellaria in infusion in as large doses as the patient 
can bear; and others the narcotics, as the Cannabis Indica, 
Belladonna, Stramonium, Hydrocyanic Acid, etc. Each has 
been employed thoroughly, and though they may have so 
mitigated the symptoms as to have led the attendant to sup- 
pose that under more favorable circumstances they would 
have been followed by success, yet we have no evidence that a 
single case has been cured. Evacuants have not only failed to 
accomplish any good result, but have undoubtedly hastened 
death. The Anagallis Purpura has been highly extolled, and 
cases reported cured, but we are not told whether it was used 
as a prophylactic previous to the full development of the dis- 
ease, or afterward, and as will be noticed, very much depends 



448 The Eclectic Practice of Medicine. 

upon this. If I had to adopt a treatment in these cases, it 
would be the continuous hot bath, Quinia in large doses, and 
Chloroform by inhalation. 



DELIRIUM TREMENS. 

Delirium tremens, in a very large majority of cases, is the 
result of intemperance in the use of intoxicating liquors, and 
usually follows a protracted debauch. It may be produced by 
the habitual use of Opium, and in rare cases it may result 
from excessive emotional excitement in persons of feeble 
health. As a general rule it occurs in persons who are habit- 
ually intemperate, though they may never have been so intox- 
icated as to attract much attention. It is claimed by some 
that delirium tremens is not the result of excessive excite- 
ment, but that it makes its appearance when the person has 
ceased to drink, either from inability of the stomach to 
receive it, or because they desire to sober up. Hence they 
say that it is the result of the withdrawal of the stimulant at 
a time when the system is accustomed to its use. This would 
be good reasoning were it not for the fact that in very many 
cases it comes on while the person is still drinking to excess. 
How then will we harmonize these opinions, or rather these 
facts? There is only one way, and that is, that there is a 
delirium of drunkenness following the debauch immediately, 
and another that makes its appearance in from two to seven 
days afterwards. It may be that this accounts for the great 
difference in the treatment of the disease. 

Symptoms. — Delirium tremens is usually announced by a 
marked vigilance and entire sleeplessness, though the person's 
mind may as yet be entirely clear, and free from the vagaries 
that are soon to make their appearance. We find that there 
is great irritation of the stomach, frequently thirst, some- 
times nausea, and in all cases an entire loss of appetite, the 
patient having usually taken but little if any food for several 
days. The pulse is generally slow, and the hands and feet are 
cold and clammy; he is anxious and dejected, sighs frequently, 
and complains of oppression about the praecordia. These 
symptoms continue sometimes for two or three days, at others 
for but a few hours. The restlessness and vigilance of the 
patient are now increased, and the countenance has a pecu- 



Delirium Tremens. 449 

liarly wild expression ; mental delusions now occur, at first at 
intervals, and easily displaced by reasoning with, him, but at 
last becoming fixed and constant, he sees curious shapes and 
beings, snakes, devils, dragons, assassins, etc., and is in con- 
tinual fear of his life, or of future retribution. It is singular 
that these visions are so generally frightful, and strike the 
poor sufferer with mortal terror, and yet the cases are very 
rare where it is otherwise. He sees them on his bed, peeping 
and laughing at him from behind the furniture, grasping at 
him from the air, climbing on his body, and it is impossible to 
displace these fancies. Occasionally they take human shapes, 
but are still objects of terror, as murderers, thieves, etc., and 
he tries various means to escape from their clutches, even in 
some cases to jumping out of the window. The intensity of 
this delirium varies in different cases, the patient being man- 
aged with ease in some, but in others requiring to be held 
down in bed to prevent him from injuring himself and others. 
During this time the skin is harsh and dry, the pulse frequent 
and small, the tongue dry and furred, and the appetite 
entirely lost. The secretions are all diminished, the patient is 
feeble, and there is an unnatural tremor of the muscles. Con- 
tinuing in this way for a variable period, it may terminate by 
a subsidence of the excitement, and by a deep sleep, from 
which the patient awakes free from these morbid fancies. 
In other cases the delirium becomes more and more severe, 
until finally the system sinks under it, the patient dying from 
the fourth to the twelfth day. 

Diagnosis. — The previous history of the person, the marked 
uneasiness and restlessness of his manner, and the peculiar 
wildness of his countenance, and constant watchfulness, will 
determine the nature of the disease at the commencement. 
In a more advanced stage the symptoms can not be mistaken 
by the most casual observer. 

Prognosis. — The prognosis is generally favorable, except in 
cases in which the system has been greatly shattered by long- 
continued intemperance. It is, however, many times, a very 
dangerous disease, and requires great care in its management. 
We may look for a fatal termination, if the watchfulness 
increases for two or three days and the illusions are constant 
and keep the patient in a state of continual terror and excite- 
ment, the pulse being quick and feeble. But if the watchful- 

29 



450 The Eclectic Practice of Medicine. 

ness and illusions gradually become less, with symptoms of 
drowsiness, the case will terminate favorably. 

Post-Mortem Examination. — The lesions resulting from 
intemperance are many and of various character. The digest- 
ive apparatus seems to suffer first and to the greatest extent ; 
thus we find the mucous membrane of the stomach thickened, 
of a red or reddish-brown color, sometimes like mahogany, 
and covered with a dark, flaky material ; sometimes it seems 
just on the verge of mortification. The mucous membrane 
of the small and large intestines is not unfrequently affected 
in a similar manner, though not to so great an extent. The 
liver is often enlarged, and of a yellow or fawn color, granu- 
lated or showing evidences of fatty degeneration. The ner- 
vous centers do not always exhibit sufficient change to account 
for the symptoms; frequently there being nothing more than 
slight opacity of the arachnoid, injection of the pia mater, 
and increase of the puncta vasculosa, when the brain is 
affected. Occasionally there is an increased amount of fluid 
in the ventricles, injection of the membranes, with more or 
less deposit of coagulable lymph. 

Treatment. — Delirium tremens may usually be easily 
arrested at first, and it is at this time that I prefer to treat it. 
If the symptoms are just commencing in a hard drinker, I 
frequently give a pill of #, Extract of ]S~ux Vomica, gr. 
vj ; Hydrastin and Quinia, aa, 3ss; M. and make thirty pills, of 
which one may be taken every three or four hours. Very 
many cases can be arrested in this way without trouble. In 
other cases, and especially if there is great irritability of the 
system, prolonged abstinence and watchfulness, I order a 
mixture of #, Tincture of Gelseminum, 3j ; Tincture of Opium, 
3ss; Tincture of Veratrum, 3j; Simple Syrup, 3j ; M., and give 
in teaspoonful doses every hour, with half an ounce of 
Brandy, until the patient becomes quiet and sleeps. Occasion- 
ally we may use the sedatives alone, giving Tincture of Vera- 
trum in doses of five drops largely diluted, or Tincture of 
Digitalis, in doses of a teaspoonful every two hours until the 
patient is quieted. 

When the disease is fully developed, we may occasionally 
succeed with Opium and stimulants, or with either of the 
two, though I do not like the practice. Dr. I. G. Jones gave 
Brandy in large quantity, with Hoffman's Anodyne, and con- 
tended that it was not only successful, but the most successful 



Delirium Tremens. 451 

practice known. Opium and stimulants have been employed 
by many physicians with moderate success, though the treat- 
ment will not reach difficult cases. I have used the combina- 
tion of Gelseminum, Opium, and Veratrum first named, with 
good success in cases not very severe, though it fails in the 
worst form of the disease. Tincture of Digitalis has been 
very highly recommended, and from my experience with it, I 
am inclined to believe it one of our best remedies. It is 
given in very large doses from 3j to 3ss, every three or four 
hours, until the patient becomes quiet and sleeps. 

The warm bath is usually very efficient, and I have known 
patients to go to sleep in the bath, who had been beyond all 
control, except by force; it may be associated with the other 
means named. If there is nausea, and especially if the reme- 
dies given are thrown up, an emetic should be administered, 
and the stomach thoroughly evacuated. In some cases it is 
well to evacuate the bowels with the Compound Podophyllin 
Pill, and the secretion of the skin may be started by the 
administration of Tincture of Asclepias, with Carbonate of 
Ammonia. I have cured cases of delirium tremens with the 
warm bath, Podophyllin Pill, and Asclepias and Carbonate of 
Ammonia, when Opium and stimulants had failed. In very 
severe cases, we would place the patient under the influence 
of . Chloroform, aud continue it until natural sleep was the 
result. When other remedies fail, we are enabled to manage 
the disease with anaesthetics, until we can get the desired 
action from medicines. As the excitement is subdued, it 
becomes important to give the patient food in such form that 
it may be appropriated by the enfeebled digestive organs; 
animal broths and milk are usually best adapted to the case, 
and should be given at first at regular intervals if the patient 
has no appetite, as is generally the case. Very frequently the 
restlessness depends more upon a lack of nutritive material 
and consequent exhaustion than it does upon disease ; and as 
soon as the stomach appropriates the proper amount of nour- 
ishment, the excitement subsides and sleep results. Quinia 
and Hydrastin may be given for the purpose of stimulating 
the stomach and inducing a desire for food, and in the later 
stages of the disease is very successful. 



452 The Eclectic Practice of Medicine. 



CHOREA. 

This affection, known commonly as St, Vitus 9 Dance, occurs 
most generally about the age of puberty, though it some- 
times appears as early as the sixth or eighth year, and as late 
as the thirteenth, and in some cases later than this. It is con- 
fined principally to the female sex, but in rare cases it is met 
with in the male. Most generally it is associated with some 
derangement of the sexual organs, and it is not unfrequently 
associated with hysteria. We usually find H in persons of 
feeble health, and precocious mental development^ but in 
some cases, in persons of the opposite character, in which it 
may be induced by torpor of the liver and bowels, deranged 
secretion of the skin and kidneys, and from close confinement 
or sedentary occupations. 

The modern disease received its name, doubtless, from the 
dancing maniacs of the middle ages. The "dancing plague" 
or St. Vitus' dance, commenced in Strasburg, in 1418, and 
is thus described by Burton: "Chorus Sanctse Viti, the las- 
civious dance as Paracelsus calls it, because they that are 
taken with it can do nothing but dance till they are dead or 
cured. It is so called for that the parties were wont to go to 
St. Vitus for help, and, after they had danced there awhile, 
they were certainly freed. 'Tis strange to hear how long they 
will dance, and in what manner, over stools, forms, tables ; 
even great-bellied women sometimes (and yet never hurt their 
children) will dance so long that they can stir neither hand 
nor foot, but seem to be quite dead. One in red clothes they 
can not abide; music above all things they love; and there- 
fore magistrates in Germany will hire musicians to play to 
them, and some lusty, sturdy companions to dance with them." 

Another form of the dancing mania termed St. John's 
Dance, commenced in 1374, and extended over the greater 
portion of Europe. "At Cologne the number possessed 
amounted to more than five hundred, and at Metz the 
streets are said to have been filled with eleven hundred 
dancers. Peasants left their ploughs, mechanics their work- 
shops, housewives their domestic duties, to join the wild 
revels, and this rich commercial city became the scene of the 
most ominous disorder; secret desires were excited and too 
often found opportunities for wild enjoyment; and numerous 
beggars stimulated by vice and misery, availed themselves of 



Chorea. 453 

/* 
this new complaint to gain a temporary livelihood. Girls 
and boys quitted their parents, and servants their masters, to 
amuse themselves at the dances of those possessed, and greed- 
ily imbibed the poison of mental infection. Above a hundred 
unmarried women were seen roving about in consecrated and 
unconsecrated places, and the consequences were soon per- 
ceived; gangs of idle vagabonds, who understood how to 
imitate to the life the gestures and convulsions of those really 
affected, roved from place to place seeking maintenance and 
adventures, and thus, wherever they went spreading this dis- 
gusting spasmodic disease like a plague; for in maladies of 
this kind the susceptible are infected as easily by the appear- 
ance as the reality." (Hecker.) 

This gives the origin of the name of the affection we are 
now considering, and though there is no similarity between 
the ancient and modern St. Vitus' dance, the description just 
given illustrates the ease with which nervous affections of this 
kind may be propagated. And it is a fact, proven by numer- 
ous instances in hospital practice, that attacks of hysteria, 
epilepsy, and chorea will be excited by witnessing the malady 
in another. 

As regards the pathology of the affection, we must conclude 
that there is an irritation of the true spinal cord, arising 
sometimes from debility, and at others from extrinsic causes 
of irritation. In either case the excitation of the nervous 
system is indicative of debility, rather than strength, and in 
many cases is based upon feeble nutrition of the nerve sub- 
stance. 

Symptoms. — The first evidences of chorea are occasional 
involuntary movements of the hands and facial muscles, and 
an inability to sit quietly in one position. Very frequently 
the fingers are quickly and involuntarily moved, and when 
the patient uses the hands it is with a quick unnatural move- 
ment. As the disease progresses the involuntary movement 
becomes continuous, some part of the body being constantly 
in motion, and the movements are now very much exaggerated. 
If the patient attempts to do anything, she seems to have but 
partial control over her muscles, and while they are being 
directed to the end intended, they are going through a suc- 
cession of movements entirely independent. So great is this, 
sometimes, that the patient can not sit still, nor keep the 
hands quiet for a moment, and her walking is irregular from 



454 The Eclectic Practice of Medicine. 

the same cause. The facial muscles are sometimes very much 
involved, and the attempt to speak, or give expression to the 
emotions, is followed by various contortions of the counte- 
nance, which would be laughable were they not connected 
with so serious a malady. Sometimes it is almost impossible 
for the patient to express herself intelligibly, owing to spas- 
modic action of the muscles of the mouth and of the larynx. 
As before remarked, the general health is usually impaired 
previous to the commencement of the disease, and this 
becomes more marked, as it progresses ; symptoms of anaemia 
are of common occurrence, the skin being blanched, the pulse 
feeble, the lips and gums pale, variable appetite, imperfect 
digestion, and constipation of the bowels. The mind is more 
or less affected, the patient being low-spirited, and desiring 
solitude, the countenance being pale, languid and vacant. In 
some instances confirmed chlorosis will be developed- during 
the progress of the disease. It will be noticed, that the child 
has no disposition to play or to take exercise, and does not 
desire to associate with others, but prefers rather, to get where 
her infirmity will not be noticed; the sensitiveness in this 
respect being sometimes very great. 

Diagnosis. — Chorea is marked by such distinctive symp- 
toms that it is easily recognized, the continual partly voluntary 
and partly involuntary movements not being observed in any 
other disease. 

Prognosis. — Though in some eases very obstinate, the dis- 
ease is almost always curable. It may last for two or three 
weeks, or, as many months, and in some rare cases for years. 
Usually it disappears as the general health is improved. 

Post-Mortem Examination. — In fatal cases the evidences of 
anaemia are usually very marked, the tissues very pale, soft, 
and flaccid. The different organs have been found more or 
less diseased, but these were complications and bore no rela- 
tion to the spasmodic action. "We would expect to find lesions 
of the brain and spinal cord ; but except in those cases termi- 
nating in general convulsions, or in inflammation, no change 
of structure has been noticed. 

Treatment. — Various plans of treatment have been adopted, 
and many remedies used as specifics in this affection, and as 
is usual, we find that where the means are so abundant, they 
are not very efficient. "We had much better adopt a rational 
plan of treatment, by correcting any dyserasia, and getting a 



Chorea. 455 

normal performance of the various functions of the body, 
rather than depend upon any one remedy, no matter how 
highly it is praised. Derangement of the digestive apparatus 
is usually prominent and its correction is frequently followed 
bv speedy recovery. Thus in many cases we will commence 
the treatment by the administration of a thorough emetic, 
which may in some cases be repeated with advantage once or 
twice a week. This should be followed by a mild cathartic 
of Podophyllin, Leptandrin and Extract of Hyoscyamus, in 
doses sufficient to move the bowels once or twice daily, until 
recovery is complete. Associated with this we would give a 
bitter tonic, as Quinia, Hydrastin, aa, 3ss ; Extract of !Nux 
Vomica, gr. ij ; Extract of Macrotys, q. s ; make thirty pills, 
and give one four times a day. A preparation of Iron is 
almost always necessary, and we may use the Prussiate, Car- 
bonate, or the Ammoniated Tartrate, which has been very 
highly recommended. In all cases we employ the bath to 
sustain a normal action of the skin, and for its general influ- 
ence; I have obtained better results from the Salt water 
sponge bath, with brisk friction, especially of the entire length 
of the spine, than from any other means. 

If the disease is associated with amenorrhcea, or irregularity 
of the menstrual function, this must be attended to. In some 
cases the emmenagogue pill of the Dispensatory, will prove 
useful, both as a cathartic and for its action on the uterus. 
The "Wild G-inger is another agent that will prove useful in 
some of these cases. The Macrotys or Cimicifuga is a very 
valuable remedy, especially in cases where the patient com- 
plains of wandering pains in various parts of the body, or pain 
in the back and limbs. "We sometimes associate it with Val- 
erian or Scutellaria, and sometimes with the bitter tonics. 
The Extract of Indian Hemp has been employed with benefit, 
in doses of half a grain three times a day, and good results are 
said to have attended the administration of small doses of 
Stramonium. The Sulphate and Oxide of Zinc have been 
prescribed oftener possibly than any other agents, and we 
must believe from the favorable reports given that they have 
an action in these cases ; these remedies may be given com- 
mencing with half grain doses four times a day, and gradually 
increased until five or ten grains are administered. 

If there is tenderness on pressure over the spinal cord, coun- 
ter-irritation will often prove very efficient, and the same will 



456 The Eclectic Practice of Medicine. 

be the case when there is tenderness on pressure over the epi- 
gastrium. Electricity has been frequently resorted to in 
chorea, and the reports of its action differ materially. When 
passed through the limbs it is not only useless, but sometimes 
positively injurious, but when applied to the back alone it is 
almost always beneficial. The common electro-magnetic 
machine may be employed, the negative pole being applied to 
the sacrum, and the positive passed backward and forward 
over the spine. The better plan however, is to insulate the 
patient, and by the old fashioned electric machine, charge the 
patient and withdraw the spark from the back. In one case 
lately I have employed the Bromide of Ammonium in addition 
to the tonic treatment first named, and seemingly with marked 
benefit, though one case no more demonstrates the curative 
action of a remedy, than that one swallow makes a summer. 

Very much will depend upon the home management of the 
patient. All causes of irritation must be carefully avoided, 
and she should be encouraged to take suitable exercise, and 
try to control the involuntary movements. Out-door exer- 
cise, pleasant company, and something to constantly occupy 
the mind with, exerts an important influence, and it will some- 
times be found that where the patient is allowed to have her 
own way, if not decidedly improper, she will get along better. 
In some cases the disease results in both male and female, 
from sexual excitation and onanism ; this should be looked 
into, and if reasonable evidence exists, means should be 
employed to put a stop to it. The manner of doing this will 
have to be left to the discretion of the physician, and will vary 
in different cases. 



HYSTERIA. 

(see diseases of women.) 



SPERMATORRHOEA. 

It is not so much on account of the debility of the genital 
organs and loss of virility, occasioned by loss of semen, that 
we consider this disease here, but for the serious mental and 
physical depression that it occasions. [ The most frequent 



Spermatorrhea. 457 

cause of spermatorrhoea is masturbation, but it may be occa- 
sioned by excessive venery, constant lascivious thoughts, gon- 
orrhoea, diseases of the rectum and bladder, or any cause that 
will excite and continue an irritation of the genital organs. 
It comes on slowly as a general rule, and when the result of 
masturbation may be two or three years in its development. 
The subject of this vice usually has no idea of what it is lead- 
ing to, and continues the practice until the frequent occurrence 
of nocturnal emissions, induces such loss of strength and 
feebleness of mind as to cause enquiry. 

Spermatorrhoea manifests itself in the form of nocturnal 
emissions, which at first are voluntary and occur under the 
influence of a lascivious dream, and are attended by the usual 
feelings, but at last without sensation or consciousness of the 
individual. In some cases, the discharge may occur when the 
patient goes to stool, or after micturition, or from straining 
or lifting, though in very many of these cases where the per- 
sons are much alarmed we will find that the discharge is 
simply mucus from the urethra, prostate gland or bladder. 
When the habit becomes fully established, the emissions will 
occur as often as once or twice a week, or in some cases, two 
or three times in the twenty-four hours. 

The seminal fluid is changed in character, being thin, with- 
out ropiness, and of a very strong odor. 

Symptoms. — The most common symptoms at the commence- 
ment of spermatorrhoea is a shyness, inability to look a per- 
son in the face, and a desire to avoid company, especially 
strangers. It is noticed that his general health is becoming 
affected, he is weak, can not stand prolonged exertion, com- 
plains of headache, nervous trembling, palpitation of the 
heart, and dizziness. The appetite becomes variable, some- 
times voracious, but generally poor, the bowels are consti- 
pated, the skin pale and sallow, the hands and feet are cold, 
and he rests badly at night. At a still further advanced 
stage of the disease, the loss of strength becomes more 
marked, as does the depression, nervousness in the presence 
of company, and the other symptoms named. Frequently 
they will not look any person in the face, if it is possible to 
avoid it, and shun company as much as possible. The mind 
now becomes seriously affected; there is loss of memory; he 
is cowardly ; has no faculty for business ; and, as Dr. Gross 
well remarks, "is physically and mentally emasculated." If 



458 The Eclectic Practice of Medicine. 

it continues it will terminate in epilepsy, insanity or idiotcy, 
and the physical prostration in some cachectic disease, as 
phthisis, acute hydrocephalus, diabetes, etc. 

Diagnosis. — The diagnosis of spermatorrhoea is very diffi- 
cult, as though some of the symptoms named are very char- 
acteristic; there are none but what may be produced from 
other causes. A careful analysis of symptoms will always 
lead the practitioner to suspicion spermatorrhoea as the cause, 
when, with proper care, a full admission, with a complete his- 
tory of its origin and progress, may generally be obtained 
from the sufferer. Considerable tact will sometimes be neces- 
sary, but usually the conversation and questions can be so 
guided as to elicit the major part of the information neces- 
sary without exciting the patient's suspicions, and when the 
clue is thus obtained, it is easy to follow it up. 

Prognosis. — The prognosis is favorable in a majority of 
cases, especially if appropriate treatment is adopted early in 
the disease. There is a class of cases that are beyond the 
reach of medicine, and will sooner or later terminate fatally. 
Not unfrequently we find that the patient's mind has been 
morbidly excited by the reading of advertising disquisitions 
upon the subject, or by consulting some of the numerous 
leeches who pretend to make private diseases a specialty. 
This excites an unnatural fear, and his attention being fixed 
constantly upon the subject, his imagination is so wrought up, 
that serious injury to the health ensues, and he will absolutely 
have many of the symptoms described. Thus, I have seen 
cases that had followed this course, and who had become 
seriously diseased both in mind and body, and yet had not at 
any time had spermatorrhoea. 

Treatment. — A careful examination of the genital organs 
should be made to determine the existence of increased sensi- 
bility, and with a bougie to determine the existence of irrita- 
tion of the urethra. In some cases the bowels should be kept 
open by a mild cathartic and the use of the cold water injec- 
tion, thus removing a permanent cause of the irritation of 
those organs. In other cases we will find an irritation of the 
bas-fond of the bladder, with increased secretion of mucus, 
and large deposit of the triple-phosphate ; this will continue 
the irritation of the sexual organs in spite of all remedies 
given for its control, and must be removed if we expect to 
effect a cure. It can usually be readily accomplished by the 



Spermatorrhea. 459 

use of a tepid water injection into the bladder, sufficient to 
thoroughly wash it out, and, in bad cases, followed by an 
injection of Chloride of Zinc, gr. j, Water, 3j, or the means 
named under the head of cystitis. Occasionally the use of 
leeches to the perineum, or counter-irritation, or the warm 
sitz bath will relieve the increased sensibility. If, on passing 
the bougie, an irritable point is found, generally in the pros- 
tate portion of the urethra, it should be cauterized with Lalle- 
mand's Porte Caustique, the patient using the demulcent 
diuretics for some days afterwards. 

Internally, we frequently employ the Bromide of Potas- 
sium, in doses of from three to five grains four times a day, 
and if there is great irritability of the organs, with frequent 
erections, we may associate Camphor with it. Certain tonics 
seem to have an excellent influence in this disease, and as we 
have to employ agents of this class, we employ them. Cornus 
Florida, Collinsonia and Euonymus, seem to be especially 
applicable, and may be associated in the following manner: 
#, Essl. Tincture of Cornus, Collinsonia and Euonymus, aa, 
f3j ; Bromide of Potassium, 3j ; Glycerin, Simple Syrup, aa, 
3ij ; M., and give in teaspoonful doses four times a day. If 
the prostration is great, I usually employ the !N"ux Vomica 
and Quinia pill, as, #, Extract of Nux Vomica, gr. v; Hydras- 
tin, Quinia, aa, 3ss; M., and make thirty pills, of which one 
may be taken three or four times a day. In some cases the 
use of Iron, or Cod- liver Oil, will prove advantageous; and 
should there be deposits of the lithates or oxalates in the 
urine, we may use the mineral acids as heretofore named. 

It is necessary that the patient should have the disease so 
explained to him, that the morbid fear that is so frequently 
noticed shall be removed, and for this purpose we will try to 
gain the patient's implicit confidence. If this is not done, we 
will frequently find our remedies unavailing. The patient 
should be directed to take exercise in the open air, to use a 
daily bath, confine himself to a nutritious and not stimulating 
diet, and sleep on a hard bed. An entire abandonment of 
masturbation, and sexual excitement as far as possible is 
imperative, and he should likewise be cautioned not to let his 
thoughts turn to these subjects. There is no doubt but that 
the will can materially aid in controlling this unnatural exci- 
tation, and if possible it should be made to assist in the cure. 

" The practice of onanism often engenders a want of confi- 



460 The Eclectic Practice of Medicine. 

dence in young men, in regard to their ability to consummate 
the marriage contract. In fact it renders them sometimes 
temporarily impotent. I have repeatedly known this to be 
the case after the marriage had taken place, much to the 
annoyance both of the patient and the surgeon. In general, 
however, the defect is rather in the mind than in the body, 
and may be easily corrected by entire abstinence for several 
weeks, and by the use of a little medicine, such for instance, 
as a few drops daily of equal parts of Tincture of Nux Vom- 
ica, Chloride of Iron, and Cantharides, with the assurance of 
speedy recovery. In this way, confidence is restored, and the 
difficulty, of course, soon vanishes. Occasionally the obstacle 
is caused by too great an eagerness on the part of the indi- 
vidual, or by too frequent indulgence soon after marriage. At 
other times, again, the erections are imperfect, and the act is 
prevented by a premature emission. These effects frequently 
subside of their own accord ; when they do not, an attempt 
should be made to correct them by a judicious course of 
treatment, especially the use of tonics, the shower bath, gal- 
vanism, and attention to the bowels and secretions, aided, if 
the parts be morbidly sensitive, by cauterization of the 
urethra, and mildly astringent injections." (Gross.) 



HYPOCHONDRIASIS. 

Among the most troublesome cases that come under the 
physician's care, are those which may be classed under the 
present head, and though they may vary greatly in their 
symptoms, there is that common to all, which gives them a 
distinctive character. 

Copland's definition, " Chronic indigestion, with languor, 
flatulency, dejection of mind and fear, arising from inade- 
quate causes ; general exaltation of sensibility, a rapid suc- 
cession of morbid phenomena, simulating numerous diseases, 
or otherwise a real but variable state of suffering, exaggerated 
by the morbid sensibility and fears of the patient, with 
unsteadiness or variability of purpose, and distressing anxiety 
respecting his complaints." This in a few words expresses a 
condition in which, in addition to a variable amount of phys- 
ical disease, we have a marked lesion of innervation, and to 
some extent of the mind. Some authorities class it with 
insanity, and there are cases sometimes grouped under this 



Hypochondriasis. 461 

head, in which the patient imagines himself a tea-pot, or a 
locomotive, or that his body has so increased in size that he 
can not get through the door, or has a morbid dread of 
thieves, assassins, etc., which properly belong to that class. 

The causes of hypochondriasis are various. Sometimes a 
disposition to it seems to be hereditary, making its appear- 
ance after middle age from slight exciting causes. It usually 
results from prolonged mental exertion, or letting the mind 
dwell constantly on one subject, and especially in persons of 
sedentary habits. 

"Whatever exhausts, or directly depresses cerebral power, 
as intense application of the mind to difficult or abstract sub- 
jects, anxieties respecting schemes, speculations, or objects of 
ambition; disappointments, sorrow, fright or sudden alarm; 
the depraving passions, severe losses of fortune, or friends, 
indulgence of sombre or sad feelings; devotion to music and 
the fine arts, reading medical books, etc., and whatever favors 
congestion of the brain, may cause the complaint." (Copland.) 

Symptoms. — In a majority of cases we find considerable 
derangement of the digestive organs; the tongue is coated at 
the base, there is clamminess and bad taste in the mouth in 
the morning, digestion is attended with flatulence and eructa- 
tions, and the bowels are constipated. The secretions are 
deranged; the skin being dry and harsh, or soft, pale and 
relaxed, with feeble circulation and coldness ; the urine is usu- 
ally copious but deposits the lithates or phosphates. There is 
marked hyperesthesia in many cases, the sensibility being so 
exalted, that the slightest suffering is magnified into intense 
pain, and there is constant suffering from wandering pains in 
various parts of the body. 

Occasionally the patient seems dull and impassive, brooding 
over his troubles and diseases, and seems to feel no acute suf- 
fering, and is with great difficulty aroused so as to describe his 
imaginary diseases, answering, that he knows them to be such 
as are incurable by medicine, and therefore it is useless to 
describe them. In the one case the patient is always com- 
plaining, and evidences of suffering are well marked; in the 
other it is very evident that the patient is diseased, but he is 
wrapped up in himself, and constantly brooding over his 
diseases, rather than complaining about them. 

In many cases the patient, notwithstanding the severe char- 
acter of the symptoms, presents all the appearances of sound 



462 The Eclectic Practice of Medicine. 

health. " He often complains of violent pains in the temples, 
forehead, or occiput, or of a general headache, with dimness 
of sight, and noises in the ears, or of a sense of weight or 
pressure, more intolerable than pain at the vertex, with giddi- 
ness or confusion of mind ; and sometimes of a constriction or 
lightness of the head or temples, or of a morbid sensibility of 
the scalp and roots of the hair. Occasionally the senses are 
morbidly acute, and intolerant of light and noise. Pains 
resembling rheumatism, or those of syphilis, are felt in various 
situations, occasionally with a feeling of burning or heat, and 
sometimes of coldness, horripilations, cramps, feebleness, or 
threatened paralysis of one or other of the extremities. Weak- 
ness of the limbs, unsteadiness in walking, or feebleness of the 
joints (in some instances with neuralgic pains) and great sus- 
ceptibility to cold and heat, are not unfrequently complained 
of. The morbid sensibility of the hypochondriac is generally 
increased by a cold and humid state of the atmosphere, by 
easterly winds, and by very warm seasons. His mind is inca- 
pable of exertion or prolonged attention, although when 
aroused, he may be lively and acute ; but he soon becomes 
engaged in his own feelings and sufferings. To these he fre- 
quently recurs in conversation, whenever he has an opportu- 
nity of doing so, although he seems to suspect that the subject 
is unpleasant to those who listen to him, and therefore sup- 
presses a part of his complainings. In some cases there is 
dyspnoea, constriction of the chest, with a dry, short, or spas- 
modic cough, and occasionally a sense of suffocation or con- 
striction is felt in the throat, with flatulence and various other 
symptoms resembling those attendant on hysteria. These 
phenomena have induced several writers to consider the dis- 
ease closely allied to hysteria, and the severe palpitations, or 
irregular action of the heart, frequently also complained of, 
have further countenanced the idea ; while they have excited 
the anxiety of the patient and induced him to believe him- 
self the subject of irremediable disease of the heart; sleep is 
sometimes materially disturbed, and occasionally the hour of 
repose is ardently looked for ; but in other cases it is dreaded 
as aggravating the distress. The patient is often tortured 
with the most distressing feelings, which are greatly aggra- 
vated by his fears. He dreads impending dissolution, from the 
symptoms referred to the head, heart or chest. His ideas are 
concentrated on himself and his feelings, and he is incapable 



Hypochondriasis. 463 

of attention or mental exertion, unless by circumstances of 
unusual interest or moment. Occasionally vertigo, dimness 
of vision, and intolerance of light and noise, are so great as to 
justify his fears; and the pains in the head, or the sensation 
of pressure on the head and temples, are so severe, that the 
eyes seem starting from their sockets." (Copland.) 

Diagnosis. — The diagnosis requires considerable care, as all 
of the symptoms named as occurring in hypochondriasis may 
be occasioned by real diseases. Our suspicions are generally 
excited by the expressions of severe suffering in slight dis- 
orders, and by the little constitutional disturbance occasioned 
by the grave affections that the patient would seem to have. 
A close examination will detect that the diseases complained 
of, do not exist at all, or if they do, in a form that would not 
give rise to the symptoms complained of. This is especially 
the case as regards diseases of those organs that may be 
examined physically, as the heart, lungs, etc. And in other 
cases the diagnosis is confirmed by the frequent shifting of 
the disease from one part to another, and the speedy disap- 
pearance of what had seemed to be structural disease. 

Prognosis. — In the early stages of hypochondriasis we may 
give a favorable prognosis, as in a very large majority of 
cases, proper medication, if we can gain the confidence of the 
patient, will be attended by a speedy cure. In cases, how- 
ever, which have lasted for years, we will be guarded in our 
opinion, as many of them can not be relieved, and the patient's 
confidence is best gained by holding out inducements of cure, 
as he seems to gain under the treatment. 

Treatment. — It is necessary that we carefully analyze the 
symptoms of the case, and determine as near as possible the 
exact nature of the functional lesions present, and their 
extent, and proceed to remove them seriatim. In many 
cases, we will give attention first to the digestive organs, 
removing torpidity of the stomach, increasing the power of 
digestion, and overcoming constipation. An emetic adminis- 
tered once or twice a week until the coating no longer forms 
on the tongue, and the bad taste of the mouth and fetid 
breath disappears, is sometimes attended with the most 
marked beneficial results. The Compound Powder of Lobelia 
and Capsicum in infusion will be the best remedy for the pur- 
pose and should be so used as to thoroughly evacuate the 
stomach. It is especially indicated in cases where the tongue 



464 The Eclectic Practice of Medicine. 

is coated at the base, with a bad taste in the mouth, slight 
nausea, and fetid breath. It may be followed by a purgative, 
as, #, Podophyllin, gr. xx; Aloes, 3j; Extract of Nux Vomica, 
gr. v; Hydrastin, 3ss; Extract of Hyoscyamus, q. s.; M., and 
make forty pills, of which one may be given two or three times 
a day, so as to open the bowels once or twice daily. An alka- 
line diuretic as the Acetate or Citrate of Potassa, and the 
daily use of the salt bath, with brisk friction, will sometimes 
complete the treatment. Very frequently a succession of 
tonics, stimulants and chalybeates will be required, for one 
will lose its effect in a few clays or weeks, and will have to be 
replaced by a new one. Keeping the secretions free, is only 
next in importance to maintaining the digestive organs in 
proper condition, and we will here derive marked benefit 
from remedies directed to the kidneys, and from the use of 
various baths as may be indicated by the condition of the 
patient. I have seen most marked advantage result from the 
use of the warm bath followed by cold affusion and brisk 
friction, and in some cases from cold affusion alone, or 
directed principally to the spine. Occasionally when the skin 
is relaxed and flabby, much benefit is derived from the tonic 
and astringent baths heretofore named. 

In those cases attended with symptoms of heart disease, 
but without structural change, and which undoubtedly orig- 
inate from derangement of the stomach, we will find no bet- 
ter agent than the Collinsonia. I have frequently associated 
it as follows : #, Essl. Tincture of Collinsonia, Essl. Tincture of 
Asarum, aa, 3ij ; Simple Syrup, 3iv; M., and give in tea- 
spoonful doses every four hours. We may occasionally add 
to it the Tincture of Xanthoxylum, or the Tincture of Nux 
Vomica. The Prussiate of Potash will sometimes prove 
beneficial in this case, in closes of from three to five grains 
four times a day. If there is difficulty of breathing and 
feeling of oppression, with a dry, hacking, troublesome 
cough, and especially if it causes restlessness at night, I pre- 
fer the Tincture of Drosera, in the proportion of f* 3ij to 
"Water, 3iv, in doses of a teaspoonful four or five times 
a day. The Tincture of Verbascum will likewise prove 
efficient in these cases. If there is troublesome pains in the 
head with dizziness, and feeling of tension, in addition to the 
Acetate or Citrate of Potassa, which are sometimes sufficient, 
we may give the Tincture of Jeffersonia in doses of a tea- 



Neuralgia. 465 

spoonful every three or four hours, and may expect marked 
benefit from its use. If there is urinary deposit, this should 
be examined by the microscope, and its character determined 
and the treatment necessary in the case adopted. 

It is very essential that we shall obtain the confidence of 
our patient, inasmuch as it enables him to rid himself of 
much of the burthen of watching his symptoms, and of taking 
those precautions to ward off disease, that have hitherto occu- 
pied so considerable a part of his attention. The mind thus 
relieved may be directed to other objects, and in a short time 
will get into a new channel, much to the patient's benefit. 
If the patient's confidence is not gained, no good will result 
from any treatment ; change of scene is often advisable, and 
traveling is frequently productive of great benefit. Watering 
places may be recommended, if from the character of the 
patient we think he will enter into the amusements of the 
place, if not, continuous traveling is better. Dr^ Gully 
remarks, "that the mental distractions accompanying the par- 
ticipation in exciting social scenes, the vigorous exertions of 
the voluntary power employed in strong muscular exercise, 
and the shocks given to the entire nervous system, are always 
beneficial in this complaint. The hypochondriac should be 
persuaded to the exertion of his volition in active muscular 
exercise, he does not lack muscular power, but he wants the 
mental energy necessary to its exertion. He should always 
ride or walk before his meals, rise early, and take half an 
hour's exercise in the open air before breakfast. His mental 
faculties, also, should be entirely engaged, on matters alien to 
his personal health. His imagination should be aroused and 
directed to other subjects. " 



NEURALGIA. 

Neuralgia should be considered as a morbid exaltation of 
the sensibility of nerves, sometimes the result of determina- 
tion of blood, but more frequently without perceptible change. 
"We have already noticed some of these affections, and may 
group the remainder together in this article. It may attack 
any portion of the body, and runs in the course of the sensitive 
nerves, some parts seeming to be more susceptible than others. 
The predisposing causes are usually such as enfeeble the body, 
30 



466 The Eclectic Practice of Medicine. 

and cause excitation of the nervous system ; the most frequent 
exciting eause^are damp and cold, though it may result from 
excessive emotional excitement, and as we have already 
noticed, from malaria. It is not confined to external parts, but 
may affect any of the internal organs, being most generally 
associated with slight structural disease. 

Neuralgia is sometimes preceded by a sensation of formica- 
tion, or numbness, and sometimes by soreness and stiffness. 
The pain usually comes on gradually, is at first obtuse and 
aching, but as it continues becomes sharp, lancinating, darting 
and lacerating. Sometimes it seems to be confined to the one 
spot, but at others it shoots along the course of the nerve, 
either in the direction of the trunk, or the extremities, or 
seems to dart through the part in a direction opposite to the 
course of the nerves. The pain is usually very intense, so 
much so, sometimes, that the patient screams with the agony, 
and in very severe cases becomes unconscious or maniacal 
from the intensity of the suffering. Occasionally we notice 
other disturbances of the part, as twitcbings and involuntary 
muscular movements, and derangements of function, and in 
rare cases seeming paralysis. The constitutional disturbance 
varies greatly in different cases, depending upon the severity 
of the disease, and its duration; in common cases, when it 
has continued for twenty-four hours or more, we find an 
excitement of the pulse, dry skin, constipated bowels, coated 
tongue and loss of appetite, the patient complaining that the 
extreme suffering has made him sick; in protracted cases, 
the health suffers very much, the patient becoming feeble 
and anaemic, and troubled with various functional derangments. 

Neuralgia faciei, facial neuralgia, is one of the most com- 
mon forms met with, and when persistent and severe, has 
received the name of tic douleureux. It may have its origin 
in irritation of the dental branches of the fifth pair of nerves, 
from caries of the teeth, or may result directly from cold, 
atmospherical vicissitudes, or the other causes named. It 
usually commences as a soreness in the course of the nerves, 
with slight twitching pain, but when fully developed, is sharp, 
lancinating and tearing. It may be confined to either of the 
branches of the fifth pair, affecting the eye and parts supplied 
by the first branch — or those situate over the superior maxil- 
lary bone, and supplied by the second branch — or those over 
the inferior maxillary, and supplied by the third branch. 



[Neuralgia. 467 

There are other cases in which these entire structures seem to 
be involved, the pain being confined to the terminal extrem- 
ities of the nerve. In others again, the pain is deep seated, 
situate in the course of the infra-orbital nerve within the infra- 
orbital canal, or in the course of the mental nerve as it passes 
through the inferior maxillary bone, or deep seated in the 
superior maxillary in the course of the dental nerves. 

It sometimes requires considerable care to diagnose these 
cases, as such pain may sometimes result from inflammatory 
or other diseases. We may diagnose neuralgia from struc- 
tural disease of the eye by the fact that in the latter there is 
great susceptibility to light, disordered vision, and constitu- 
tional disturbance. In disease of the antrum, or superior 
maxillary bone simulating neuralgia, the pain is frequently 
tensive and throbbing, and close examination will almost 
invariably detect enlargement or deformity; this is the case 
also in disease of the inferior maxillary. It is impossible to 
determine the existence of disease in the course of the trunk 
of the fifth pair until it passes from the cranium, and of the 
nerves when deep seated, and we will have to be guided in 
great part by the evidences of constitutional disturbance. 

Neuralgia of the back is not of frequent occurrence, but is 
sometimes very severe. The pain is lancinating and darting, 
and frequently extends outward in the course of the nerves 
passing from the spine. Thus, in the cervical region it extends 
to the shoulder, and frequently to the arm, and is sometimes 
attended with tonic contraction of muscles, producing torti- 
collis. In the dorsal region it may be confined to the spine, 
but more frequently extends to the intercostal nerves, and is 
sometimes very severe. It is very difficult to distinguish neu- 
ralgia of the lumbar region from lumbago, and as the treat- 
ment differs but slightly, it makes but little difference. 

Neuralgia of the lumbar nerves is sometimes met with, and is 
usually recognized by the course of the pain, as more than 
one branch is usually affected, and the pain is confined closely 
to the track of the nerve. Thus, we will find it in the course 
of the three cutaneous branches, as the spermatic, genito- 
crural, or extending downward in the course of the crural as 
far as the knee-joint, or even the foot. Neuralgia of the hip- 
joint, the pain being located in front, under the psoas, belongs 
to the same class. 

Neuralgia of the sacral nerves is of very frequent occurrence, 



468 The Eclectic Practice of Medicine. 

and is usually associated with some disease of the genito- 
urinary organs, or rectum, though it may be but slight. A 
very common place for the pain to point is near the rectum, 
and here it gives rise to the most exquisite suffering; at other 
times it seems to affect the entire perineum, or is confined to 
the pelvic viscera, or is located in the symphyses. Among 
the most troublesome and persistent forms of neuralgia is that 
of the hip-joint, which is associated with sacral neuralgia; 
the pain in this case is principally in the gluteal muscles, and 
those of the posterior aspect of the thigh. 

Sciatic neuralgia is a very common form of the disease. It 
usually commences between the great trochanter and the 
ischium, extending downwards in the course of the nerve to 
the popliteal space, and in some cases along the anterior and 
posterior tibials to the feet. The pain is very acute, and its 
occurrence usually sudden, though sometimes it is preceded by 
painful tinglings, slight numbness, or chills and formication. 
It is usually remittent, the exacerbations occurring in the 
afternoon and evening, or sometimes several times a day, and 
occasionally attended with constitutional symptoms, owing 
to the severity of the sufferings. Motion increases the pain, 
and sometimes brings on a violent exacerbation. In some 
cases, when the disease continues for a long time, or occurs 
frequently, the limb becomes wasted and partially paralyzed. 

Neuralgia may occur in any part of the course of this 
nerve or its various branches. A very severe and troublesome 
form of it is met with in the foot, or in both feet, and is most 
generally associated with tuberculosis, or other cachectic affec- 
tion. Neuralefia of the knee-joint is usually associated with 
that of the crural nerve. 

Neuralgia of the upper extremities is not so common as the 
lower, still it may occur and is very intense. The ulnar nerve 
seems to be the most frequent seat, the pain being acute and 
darting along the main trunk. Occasionally it seems to 
be confined to the wrist, and the articulation of the meta- 
carpal bone of the thumb, and at other times it affects the 
cutaneous nerves and the elbow joint. Chaussier states, that 
the ulnar or cubital nerve is the one most frequently affected, 
and that the pain is generally seated in that portion of the 
nerve situate between the olecranon and the internal tuberosity 
of the humerus. The temperature of the arm is increased, 
and in very severe fits the patient experiences much anxiety, 



Neuralgia. 469 

and often holds the arm up and grasps it forcibly with the 
other hand. 

Neuralgia of the muscles and membranous structures is not of 
common occurrence, and will he difficult to distinguish from 
rheumatism. But in true neuralgia of muscles, the pain is 
much more acute than in rheumatism ; recurs in frequent exa- 
cerbations, and is rarely or never altogether absent in a dull 
or numb form. "In all the cases I have seen, the remissions 
were attended by weakness or partial palsy of the muscles 
affected ; and the complaint was symptomatic of organic lesion 
in either the brain or spinal cord; an apoplectic, epileptic or 
paralytic attack, general ly occurring after longer or shorter 
periods. A lady from Gravesend, consulted me a few years 
since for neuralgic pain of the muscles of one side, and par- 
ticularly of those of the shoulder and arm of that side. After 
many months of suffering, maniacal delirium and palsy super- 
vened, several large tubercular formations were found in the 
brain after death ; indeed, as Dr. Seymour has very justly 
insisted, these severe neuralgic pains in the muscles or limbs 
should always lead to suspicion of the existence of softening 
or other organic lesions or formations in the substance of the 
brain."— (Todd.) 

Visceral neuralgia, is a not uncommon affection, and may 
affect any organ. We have already noticed neuralgia of the 
heart, and have seen that it not only occasions the most severe 
suffering, but frequently terminates fatally. Neuralgia of the 
pleura is possibly the most common form of the visceral dis- 
ease, and is marked by sharp lancinating pain, simulating 
pleurisy, from which it is distinguished by the absence of 
constitutional disturbance. It gives rise to difficulty of breath- 
ing and cough, the same as the inflammatory disease. "We 
have already noticed its frequent occurrence in the early stages 
of phthisis. Neuralgia of the stomach, has been noticed here- 
tofore, and is a very distressing form of the disease; while the 
different forms of colic illustrate neuralgia of the bowels. The 
kidneys are sometimes the seat of neuralgia; sharp lancinating 
pains occurring in the loins and darting downward in the 
course of the ureters, and sometimes as far as the testicles. 
The pain is not accompanied by constitutional disturbance, 
and neither is there much derangement of the urinary secre- 
tion, the only means we have of making a diagnosis. Even 
this is unsatisfactory, as to the presence of renal calculi, and 



470 The Eclectic Practice of Medicine. 

their passage through the ureter will give rise to the same 
symptoms. 

According to Copland, "It is extremely probable that several 
anomalous painful affections, occurring in paroxysms of extreme 
agony, which can not be referred with precision to a single 
part or organ, but which affect the diaphragm, stomach, heart, 
and their vicinity, or either of them more or less prominently, 
are actually instances of neuralgia of the nerves of association, 
and the ramifications of them, particularly of the pneum'ogas- 
tric and phrenic nerves. Several of those affections have 
been considered as instances of angina pectoris ; but, though 
nearly allied to that affection, they are more correctly instances 
of neuralgia of those nerves, the phenomena characterizing 
individual cases, varying with the ramifications specially 
affected, and with the associated affection of the ganglial 
nerves frequently accompanying them. 

Diagnosis. — Usually we have little difficulty in determining 
the character of the disease, though sometimes it is almost 
impossible. The sharp and lancinating character of the pain, 
darting along the course of the^ nerve, is more or less dis- 
tinctive, and if we associate this with the almost complete 
absence of constitutional disturbance, and evidence of local 
disease, we will come to the conclusion that it is neuralgia. 
Pressure almost always eases the pain, instead of increasing it 
as in other affections, and we observe no redness and heat, 
and but rarely swelling, and this confined to the face, or to 
the leg in sciatica. 

Prognosis. — In recent cases the prognosis is favorable, the 
disease generally yielding readily to the action of proper 
remedies. In some cases we will not promise speedy relief, 
as in those cases of severe facial neuralgia, called tic, and in 
neuralgia of the back, and of some of the viscera. In some 
chronic cases we will have to be very guarded in our progno- 
sis, for sometimes they are beyond the reach of remedies, or 
even of surgical aid. It may in severe cases terminate in 
convulsions, and as we have already seen, when it was general, 
affecting the muscles, the brain was almost always affected. 

Treatment. — The treatment of neuralgia should be both 
general and local, and contrary to the generally established 
practice we find that the first is far more successful than the 
last. In many such cases, and especially if indicated by the 
condition of the stomach, we find that an emetic will give the 



Neuralgia. 471 

quickest and most decided relief and will pave the way for a 
speedy cure. I use the Compound Powder of Lobelia and 
Capsicum in infusion, and give it so that a couple of hours 
will be occupied in its action. The patient should have his 
feet bathed in hot Mustard-water, and be covered warmly in 
bed, and take freely of some diaphoretic infusion, as of equal 
parts of Essl. Tincture of Asclepias, and Compound Tincture 
of Serpentaria, in doses of a teaspoonful every hour, or of 
equal parts of Diaphoretic Powder and Asclepin, in doses of 
five grains. Free perspiration is in this way induced and the 
patient often falls into an easy sleep, the first he has had for 
several days. In other eases we may accomplish the same 
object by the use of the wet sheet pack, and the internal use 
of cold water, and an alkaline diuretic. 

If the bowels are constipated we would employ a cathartic, 
for the removal of obstructions and for the purpose of deriva- 
tion, Podophyllin and Leptandrin with Extract of Hyoscya- 
mus or Indian Hemp, as heretofore recommended will answer 
the purpose well, and may frequently be continued every day 
until the patient is completely relieved. Great advantage is 
obtained in the more persistent cases from the continuous use 
of the alkaline diuretics, and sometimes from the Iodide of 
Potassium; the Macrotys is also a valuable remedy. "We 
might associate them as follows, #, Iodide of Potassium, 
Extract of Conium, aa, 3j ; Tincture of Macrotys, f3j ; Water, 
3ij; M., and give a teaspoonful every three or four hours. 
Tincture of Gelseminum is a valuable remedy in some cases, 
and may be given until its specific effects are manifested. 
Sometimes preparations of Guiaicum are useful, especially in 
the more chronic forms; I would prefer the alkaline tincture, 
and associate it with a small quantity of Wine of Colchicum. 
The English Wine of Colchicum seed may be given in doses 
of from ten to thirty drops every three hours, and gives 
better results if combined with full doses of the Tincture 
of Asclepias; Aconite has been employed internally with 
reputed advantage, but I have not been able to obtain satis- 
factory results with it. Belladonna in doses sufficient to pro- 
duce dilatation of the pupil will occasionally relieve the pain 
as will also the Valerianate of Zinc. Strychnia is recommended 
with Phosphoric Acid, two grains of the first to one ounce 
of the last, the dose being five drops three or four times 
daily. 



472 The Eclectic Practice of Medicine. 

In very many cases we find that the disease is markedly 
periodic, and in others though the symptoms may he ohscure, 
close observation will detect periodicity. In these cases we 
administer Quinia in full doses, giving it as we would in a 
case of intermittent or remittent fever. The medium quan- 
tity in the case of a stout adult would be fifteen grains in 
three doses ; if given in small closes it has no appreciable 
influence. It is claimed by some that Prussiate of Iron exer- 
cises a marked influence over neuralgia, and that it aids the 
Quinia in its action ; if so, we will find the old fashioned blue 
powder the best form in which to administer it. We may use 
with it the Tincture of Valerian and Gelseminumin the usual 
doses, and between the times- of giving it, a solution of 
Acetate of Potassa. The Prussiate of Potash in solution to 
the extent of from three to five grains four times a day, is 
frequently useful in obscure neuralgic affections. The local 
applications made use of vary greatly, being sedative, stimu- 
lant, narcotic, emollient, etc., according to the whim of the pre- 
scriber. Chloroform and Aconite are probably the most efficient 
agents we can use when the neuralgia is superficial, as in the 
case of the face. I use the agents combined in equal parts, 
and to such an extent as to produce the peculiar numbness 
of the tongue, characteristic of the action of Aconite upon 
the system. If we desire a stimulant influence in addition, we 
may add an equal quantity of Oil of Sassafras and Alcohol. 
If a deep seated part is affected, as in case of the sciatic nerve, 
we will find firing, or the application of a hot iron to the sur- 
face in the course of the nerve, one of the best applications. 
The strong Ammonia Liniment applied on flannel so as to 
nearly blister the part is sometimes very successful. The 
Extract of Tobacco has been successfully used as a local 
application, as has also the Emplastrum Belladonna?. Th e 
irritating plaster continued until it produces suppuration, is 
very good treatment in some chronic cases. 

In cases of visceral neuralgia, we may employ hot fomen- 
tations of Hops, Polygonum, or Stramonium, and frequently 
with the most marked relief. At other times, cold applica- 
tions will be better, and in other cases we gain the most from 
the free use of rubefacients, and sometimes from the applica- 
tion of cups. 

In severe cases of superficial neuralgia, and even sometimes 
when deep seated, we may employ Cazenve's Neuralgic Pom- 



Paralysis. 473 

ade, as, #, Chloroform, 3iv ; Cyanide of Potassium, 3iijss ; 
Axunge, 3iij; Wax, q. s., to give it consistence: this may be 
thoroughly rubbed into the part, and covered with a piece of 
oil-cloth or bladder. If these various means fail, we may 
resort to hypodermic injections, the solution of Morphia, gr. 
v, to Water 3j, being the best; from ten to twenty drops of 
this may be thrown into the cellular tissue of the part with a 
hypodermic syringe, and repeated as often as necessary. 
Acupuncture is sometimes of advantage, the needles being 
introduced through the part in various directions, and run 
through the nerve if large. Electricity will sometimes give 
marked relief, if passed from the peripheral extremities in 
the course of the nerve trunk. We may use the electro- 
magnetic machine for this purpose, but in general the con- 
tinued galvanic current from Grove's cups will be found 
better. 

In some cases, section of the nerve is the only feasible 
method of giving relief, and will sometimes be successful 
when all other means have failed. Of course it is only appli- 
cable where the nerve is superficial, and the pain distinctly 
localized, as in cases of neuralgia of the supra-orbital, infra- 
orbital, or terminal branches of the mental nerves. Simple 
incision will not answer the purpose, as the pain returns 
sometimes in a few hours. A section of the nerve must be 
removed, and as it is never renewed, there will of course be 
permanent paralysis of the parts supplied by it. In cases of 
neuralgic ulcer, having determined the most painful part, an 
incision so as to cut off the nervous supply will be followed 
by cessation of the pain and speedy healing of the ulcer. 

In other instances the neuralgia depends upon disease of a 
distant part of the body, and will not yield until that is cured. 
Thus cases of facial neuralgia have been found to depend upon 
ulceration of the cervix uteri, hsemorrhoides, or fissure of the 
rectum, and though resisting all the usual remedies, has 
readily yielded when the primary affections were properly 
treated. 



PARALYSIS. 

Paralysis, or as it is more popularly termed palsy, is the 
abolition or great dimunition of the voluntary motions, or of 
sensation, in so far as they are related to volition or con- 



474 The Eclectic Practice of Medicine. 

sciousness. It is but a symptom of disease, and not the dis- 
ease itself, as is generally imagined, and hence must be studied 
with reference to the lesions which produce it. It may be 
produced by causes arresting the production of nervous force 
in the brain, or its propagation from it; from those arresting 
generation of nerve force in the spinal cord, or most fre- 
quently its transmission through it; and lastly by changes in 
the track of a nerve that will obstruct its function, or by dis- 
ease of the nerve itself. Thus we have three distinct forms : 
1st. Paralysis from disease of the brain, or its envelops. 2d. 
Paralysis from disease of the spinal cord, or its envelops ; and 
3d. Paralysis from disease of the nerves, or parts adjacent to 
them. 

" What are the causes which may give rise to paralysis ? 
They are either an affection of the nerve or nerves, where 
power is destined in some part of their course, or a morbid 
state of the center in which the nerve or nerves are implanted, 
with which they may be less directly connected. The ner- 
vous trunks themselves may be impaired in their nutrition, 
the centre being healthy, or they may have suffered some 
mechanical injury from violence or pressure ; thus either they 
become imperfect conductors of the nervous force, or they are 
rendered altogether incapable of propagating it ; or some por- 
tion of the center of volition is the seat of a morbid process, 
whereby the influence of the will on certain parts is sus- 
pended, and thus the nerves of those parts receive no impulse 
at all from that center, whether mental or physical, and 
although perfectly healthy in themselves, are incapable of 
taking part in voluntary acts." 

" Whatever interferes materially with the conducting power 
of nerve-fibre, or the generating power of the nerve vesicles 
(gray matter) will constitute a paralyzing lesion. Thus, in the 
first place, poisoning of the nervous matter will operate in 
this way. Soak a portion of the nerve of a living animal in 
Chloroform, or Ether, or Opium, and it will fail to propagate 
the nervous force, as long as the influence of the poison lasts 
In a similar way, the poison of lead in the living system may 
paralyze by weakening the conducting or generating power 
of the nervous matter. Poisons formed in the living system 
may operate in the same way; such as retained urinary or 
biliary principles, or the poison of rheumatism or gout 
Secondly, any morbid process which greatly impairs the nat- 



Paralysis. 475 

ural structure of nerve matter will paralyze. Thus, inflamma- 
tion will do this ; so also will atrophy, or wasting from want 
of sufficient supplies of nutritious matter, as when the flow 
of Wood is lessened or cut oft*. The opposite conditions of 
hardening and of softening of nervous matter, become para- 
lyzing lesions for the same reason, that they greatly impair or 
destroy the nerve structure. Thirdly, a solution of continuity 
of nerve-fiber will paralyze. Cut a nerve across, and you 
have immediate palsy of the parts which the nerve supplies 
below the section. This solution of a continuity from a melt- 
ing down of the fibers is, I have no doubt, the frequent cause 
of sudden paralysis in cases of softening, or in cases of san- 
guineous effusions. Fourthly, pressure on a nerve or nervous 
center will paralyze; of this we have many proofs as regards 
nerves; a nerve, for instance, included in a ligature or com- 
pressed by a tumor, is paralyzed thereby. A fracture of the 
skull with depressed bone will paralyze, if the brain be suffi- 
ciently compressed; an apoplectic clot on the exterior of the 
brain paralyzes by compression; so also a tumor in its sub- 
stance. It is probably by compression that congestion para- 
lyzes; but you will, I think, find that this can not often be 
regarded as a paralyzing lesion." 

"I would say that the center of volition is of very great 
extent ; it reaches from the corpora striata in the brain down 
the entire length of the anterior horns of the gray matter of 
the spinal cord, and includes the locus niger in the crus cere- 
bri, and much of the vesicular matter of the mesocephale, 
and of the medulla oblongata. Disease of any part of this 
center is capable of producing paralysis; but as the intra-cra- 
nial portion of it exercises the greatest and most extended 
influence in the production of voluntary movements, so, dis- 
ease of this portion gives rise to the most extended and 
complete paralysis. Another fact which I would impress upon 
you, is, one which anatomy in a great degree demonstrates, 
and which pathological research confirms, that the center of 
volition for either side of the body, is not altogether on the 
same side of the body. Of the center for the left side of the 
body for instance, the intra-cranial portion is on the right side, 
and these two portions are brought into connection with each 
other through certain oblique fibers from the anterior p} 7 ra- 
midal columns of the medulla oblongata, which cross from 
right to left, decussating with similar fibers proceeding from 



476 The Eclectic Practice of Medicine. 

left to right, which belong to the center of volition for the 
right side of the body."— (Todd.) 

Paralysis from Disease of the Brain. Various morbid states 
of the brain will give rise to paralysis. The most frequent of 
these are lesions occurring during apoplexy, the palsy mani- 
festing itself immediately, or in a short time after the attack. 
It has already been noticed that in many cases of apoplexy 
there was cerebral hemorrhage and the formation of a clot, 
and in others there was effusion into the ventricles. In these 
cases the pressure may be sufficient to paralyze the sensory 
tracts, and when confined to one side, will produce hemiplegia, 
or involving both hemispheres will occasion general paralysis. 
In some cases it seems to affect but a very small portion of 
the brain — for instance the origin of the portio-clara, or the 
third pair of nerves, causing facial paralysis or squinting, but 
these cases are rare. The paralysis is usually [manifest at 
once, the apoplexy passing off*, the patient has hemiplegia or 
general paralysis. In the rarer cases the apoplectic seizure 
passes off*, but the patient finds that he has not perfect com- 
mand of the muscles of one side, or it may be only of the face, 
or of the mouth or tongue causing an impediment of speech, 
or of vision, or more frequently squinting. With these symp- 
toms there may be a sensation of fullness of the head, with a 
dull obtuse pain located at one point and fixed. These symp- 
toms may pass off in a few days, being the mildest form of 
paralysis, but in some they gradually increase, or continuing 
the same for sometimes a week or more, complete paralysis 
ensues. 

In other cases the paralysis results from chronic structural 
disease — as the formation of tumors within the cranium, 
chronic inflammation terminating in suppuration, softening of 
the brain, atrophy, and deposit of tubercles. 

In the first case there may or may not be symptoms deno- 
ting cerebral lesion prior to the occurrence of the paralysis. 
Usually the patient complains of a dull, heavy pain in a 
circumscribed portion of the brain; or occasionally it may be 
sharp, tearing, or lancinating. It does not seem to be con- 
nected with the many causes that occasion headache, and is 
sometimes attended with aberration of the senses, unsteadi- 
ness of gait, and dizziness. The paralysis is generally sud- 
den, and almost invariably hemiplegic. Chronic inflammation 
is attended by continual headache, with marked sluggishness 



Paralysis. 477 

and indisposition to mental or physical exertion. There is 
sometimes difficulty in controlling the voluntary muscles, 
impediment in speaking, and involuntary muscular move- 
ment. Softening of the brain is sometimes attended with 
but slight disturbance, especially that form of it that is known 
as white softening. Usually there is an unpleasant sensation, 
as dizziness, feeling of tension, dull aching confined to one 
part, enfeebled mind, indisposition to exertion, and imperfect 
control over the muscles, and morbid sensations as of formi- 
cation, etc. It is noticed further, that the general health is 
failing, though nutrition is but little impaired, the patient 
being feeble both in mind and body. Usually these symptoms 
are constant, but in other cases they come on and pass off for 
a period of months. Red softening is undoubtedly the result 
of inflammation, and is more acute in its symptoms and more 
rapid in its progress. Usually the patient complains of a 
severe tensive pain located in a small spot, so that it might be 
covered by the finger. There may or may not be derange- 
ment of the special senses, or of the voluntary muscles. 
These symptoms continuing for from one week to one or two 
months, paralysis is sudden, and usually in the form of hemi- 
plegia, and complete. There are no symptoms marking atro- 
phy of the brain that are distinctive. In some cases there 
seems to be a gradual loss of power, and dullness of the mind, 
and the paralysis comes on gradually. In tuberculous deposit, 
there may not be any symptom indicating the existence of 
cerebral disease, the deposit being so slow that the nervous 
substance accommodates itself to the changed condition, until 
at last, from irritation induced by its presence, determination 
of blood results, and paralysis is sudden. In other cases, we 
find it attended with headache, usually periodic, dizziness, 
derangement of the special senses, and frequent irritation of 
the stomach. 

Inflammation of the brain may terminate in paralysis, by 
the changes in structure induced by it; it is almost always 
preceded by coma; this passing off, paralysis is found to be 
present. In acute hydrocephalus, we not unfrequently notice 
partial paralysis, or there may be complete hemiplegia. Inju- 
ries of the head may give rise to paralysis, either by concuss- 
ion of the brain, by secondary inflammation, or by pressure 
in case of fracture of the bones of the cranium. 

Hemiplegia. — As hemiplegia arises in a very large majority 



478 Tee Eclectic Practice of Medicine. 

of cases from disease of the brain, this will be the appropri- 
ate place to describe it. The paralysis embraces just one half 
of the body from above downward, the lines being very accu- 
rately drawn. At first there is usually paralysis of both 
motion and sensation, but the last usually returns to some 
extent, or completely in the course of time. In mild cases, 
the face may be but little affected if any; usually the fifth 
pair is involved, but the portio-dura escapes, and we have the 
peculiar baggy condition of the paralyzed side, the face seem- 
ing to be drawn to the other side, and from the affection of 
the tongue and buccinators, there is more or less difficulty in 
speaking. Dr. Todd remarks that, " It is curious how rarely 
it happens that the muscles of the trunk, as the intercostals, 
or the abdominal muscles, are involved in the hemiplegic par- 
alysis. It must be an extensive lesion which will paralyze 
these muscles. There is, however, a spinal hemiplegia of 
which this palsy is a prominent feature." 

Hemiplegia sometimes arises from epilepsy, the paralysis 
succeeding a paroxysm. "We suppose it to result from a dis- 
turbance of the condition of the brain arising from the epilep- 
tic paroxysm, and not from sudden structural lesion. "It 
leaves behind it a more or less exhausted state of the brain; 
which again, will be most upon that side upon which there 
has been the greatest previous excitement. This state of 
exhaustion is very apt to continue as one of weakened nutri- 
tion, in which the brain tissue is more or less in the condition 
of white softening. If the parts involved in this be the con- 
volutions, mental power, memory, perception, suffer; if 
deeper parts, as the deeper parts of the white matter of the 
hemisphere, and the corpora striata and optic thalami, then 
we have hemiplegic paralysis.'* Spinal paralysis is of very 
rare occurrence, as will be readily conceived, when we know 
that the lesion inducing it will have to be very high up, just 
below the decussation of the anterior pyramids, and exactly 
limited to one half the cord. This has occurred, but as will 
be seen, it will be a very rare form of the disease. 

A very important point in this disease, as connected with 
the treatment, is as regards the condition of the paralyzed 
parts. In some cases we will find that there has been, from the 
first, complete relaxation and flaccidity of the muscles. In a 
part of these nutrition seems to be well performed and sensa- 
tion returns. In others the muscles become atrophied as time 



Paralysis. 479 

passes, and sensation may not return. In the one case the 
muscles may be thrown into action by irritation of an extrem- 
ity, or the use of electricity, in the other no such result is 
produced. In these cases the cause may be such complete 
pressure, as from a clot during apoplexy, as will entirely 
arrest the action of the nerve substance, or from softening or 
atrophy. In other cases we notice immediate rigidity of cer- 
tain muscles, others being flaccid. Dr. Todd remarks that it 
is of most frequent occurrence in the hemiplegia causes by the 
apoplectic clot, and that it depends upon a state of irritation, 
propagated from torn brain to the point of inflammation of 
the nerves of the affected muscles. In others again we will 
find marked rigidity of the muscles from the commencement, 
and in these cases we have every reason to believe there is 
excitation of the brain verging on inflammation. The prac- 
tical conclusions to be drawn from these conditions is very 
apparent ; while in the one case we may use nervous stimulants 
and tonics, to call the brain into action, in the other case we 
employ measures to arrest irritation and prevent determina- 
tion of blood. 

Paralysis from disease of the spinal cord. — Disease of the 
spinal cord produces paralysis both by arresting the production 
of nerve force in the gray substance of the cord, but especially 
by preventing the communication of the affected part with 
the brain. It almost invariably presents itself as a paraplegia, 
or paralysis of the lower parts of the body, or in rare cases as 
paralysis of a certain nerve or organ. Any cause that will 
result in destruction of the power of the spinal cord to con- 
vey nerve force will result in paralysis ; hence we find that it 
is caused by disease of the membranes resulting in effusion or 
thickening, by which midue pressure is exerted ; by inflamma- 
tion and effusion within the substance of the cord; by white 
softening, the result of atrophy or degeneration, and by red 
softening, probably the result of inflammation ; by tuberculous 
deposit within the meninges, or the nervous substance ; by 
inflammation or other disease of the vertebra, giving rise to 
effusion, or change of position and pressure on the cord; and 
lastly, from injury, either producing a shock sufficient to des- 
troy the vitality of the cord, or such lesion of the bones as will 
cause pressure. 

The diseased action that induced paralysis may continue for 



480 The Eclectic Practice of Medicine. 

a considerable period after the paralysis is marked, and then 
becomes an important element in the disease. 

Paraplegia. — Paraplegia may be said to invariably arise from 
disease of the spinal cord, though as will hereafter be noticed, 
it does not always indicate structural lesion. In the para- 
graph above, I have named the lesions of the cord giving rise 
to paraplegia, and it will be seen that in some it will be instan- 
taneous, and in others it will come on gradually. And that 
in some the evidences of the disease or condition producing it, 
will be very marked, and in other cases obscure. 

Many cases of paraplegia do not depend upon disease of the 
spinal cord, but upon some outside irritation, the paraplegia 
being reflex. Thus we observe it in some cases of worms, 
disease of the stomach and bowels, disease or displacement 
of the uterus, neuralgia, etc. 

The proof that these are the causes of the paralysis, and 
that it does not depend upon disease of the cord is very 
plain; in that the removal of the peripheral irritation is 
followed by a cure of the paralysis, and frequently that as 
the peripheral disease improves, or becomes worse, there is a 
like change in the paralysis. These cases are usually tem- 
porary and readily yield to treatment. 

The seat of the spinal lesion will determine the extent of 
the paralysis, and its gravity and intensity. If the lumbar 
spine is affected in its lower part, or at the function of the 
sacrum, there will be simple paralysis of motion in the lower 
extremities, supplied by the sacral plexus, and to but slight 
extent of sensation, as the lumbar nerves are the principal 
superficial sensory ones of the lower extremities. The bladder 
and rectum will not be affected as when the paralysis is higher 
up, and the patient may also have the power to draw the legs 
up to the body. If it involves the entire lumbar portion of 
the spine, there will be paralysis of the entire lower extrem- 
ities and of the pelvis, and the patient will not be able to con- 
trol evacuations from the bladder and rectum, only in so far 
as he may yet call into action the abdominal muscles. If in 
the dorsal region, there will be paralysis of all parts below, 
except that the intercostal nerves dip downwards in the course 
of the ribs. The upper extremities can rarely be completely 
involved and the patient live, as the phrenic nerves are given 
off from the third and fourth cervical, which go to form the 



Paralysis. 481 

brachial plexus, and lesion of the spinal cord above their 
origin is almost immediately fatal. 

The symptoms vary greatly in these cases. Iff some there is 
complete loss of motion and sensation; in others, sensation 
partially or completely returns in a few days; and in others, 
there is only paralysis of motion. When it is very severe, we 
find that the circulation is impaired, there is coldness or ten- 
dency to erysipelatous inflammation and sloughing. In other 
cases the circulation does not seem so much disturbed, but 
there is gradual atrophy of the muscles. And in a third 
class, circulation and nutrition appear to be carried on as 
usual, and the muscles respond to stimulation. 

In a part of these cases we will find more or less tonic con- 
traction, and in others complete relaxation. In some, even 
though there is manifest atrophy, the flexor muscles gradu- 
ally contract until they produce marked deformity, being hard 
and rigid under the skin, as in contraction of muscles in other 
diseases. Frequently we find more or less involuntary move- 
ment, sometimes very distressing to the patient; and in these 
cases slight irritation of the surface or tickling of the foot 
will call the muscles of the extremity into spasmodic action. 

Paralysis from disease of the nerves or from compression is 
frequently met with, the most common form being facial palsy. 
The portio-dura or facial nerve is the one most frequently impli- 
cated, and its power of transmission destroyed. This may result 
from disease of the nerve trunk, or from disease of adjacent 
structures in any part of its course causing pressure. We diag- 
nose it by the paralysis of the muscles supplied by this nerve, 
and especially the inability to close the eye on that side, the 
face being drawn to the other. It is very rarely caused by 
disease of the brain, while the fifth pair is very frequently so. 

Paralysis of a limb, or of a single muscle, may be caused by 
compression of the nerves supplying the parts. Thus, I have 
seen two cases of paralysis of the arm from tumors of the 
axilla, one being complete, the other partial. Cases of paral- 
ysis of parts supplied by the sciatic nerve from the pressure 
of tumors is recorded, and also from disease of the nerve, and 
from suppurative inflammation in its track. Usually there 
will be but little difficulty in determining the character of the 
lesion. 

Dr. Brown-Sequard contends that local paralysis is fre- 
quently the result of reflex action, and* gives the following 
31 



482 The Eclectic Practice of Medicine. 

instances: "In cases of neuralgia of the face, even when 
caused by a wound, a paralysis of the whole or of a branch 
of the third pair of the nerves is often observed. This para- 
lytic affection is easily cured when the neuralgia is cured. 
The arms may be paralyzed by a reflex action from various 
sources. In one case, after a sprain of the left elbow-joint, 
the whole of that arm from the shoulder to the elbow became 
paralyzed, and a few days afterward, the right arm was also 
attacked with paralysis, and to a greater degree than the left. 
There was no other symptom of disease of the nervous sys- 
tem, nor was there any appearance of a rheumatic affection. 
For several months a variable degree of pain remained in the 
left elbow-joint, and many times during that period it was 
ascertained that the degree of paralysis was in correspondence 
with the degree of pain, and that, when the pain ceased alto- 
gether, the paralysis was soon completely cured. It will easily 
be admitted that I studied the case with interest and care, as 
I myself was the subject of the observation. In the above 
case there was paralysis without wasting: it is not rare to find 
wasting accompany the paralysis when its origin is in some 
irritation of centripetal nerves. As regards the lower limbs, 
I have related elsewhere several such cases; as regards the 
arms, I have seen three cases in which an irritation from a 
wound on the fore-arm produced a reflex wasting palsy either 
in the same arm (in parts, the nerves of which had not been 
wounded) or in the other arm. The upper as well as the 
lower limbs, and other parts of the body, may be paralyzed in 
consequence of an irritation of the bowels by worms. Moll, 
of Vienna, relates a case of paralysis of the two upper 
extremities which had lasted three months, when it was sud- 
denly cured after expulsion of a very long taenia, and Dr. 
Holland one of anaesthesia and partial paralysis of the lower 
extremities which was cured in two days after the expulsion 
<of lumbrici. 

Wasting Palsy. — An entirely different form of paralysis is 
described by Dr. Roberts under this head, and as I have never 
seen but one case of the kind, I will quote the symptoms 
given by him. "The characteristic of wasting palsy, is a 
gradual loss of motive power from atrophic degeneration of 
the muscles, independent of any disease of the brain or cord. 
The volitional impulses proceed to the muscles without 
impediment, but the decaying fibres are no longer able to 



Paralysis. 483 

contract in response. The wasting may extend to nearly all 
the voluntary muscles, both of the trunk and extremities, or 
be confined to one or more groups in the upper or lower 
limbs. This led Aran to divide the cases into two divisions, 
according as the atrophy was partial or general. Practically 
it is important to keep the two groups distinct. The gravity 
of wasting palsy, so far as the part is concerned, is commensu- 
rated with its extent, but so far as life is concerned, it depends 
on the location. So long as the disease is limited to the 
extremities, life is not imperiled, but as soon as the muscles 
of respiration are attacked, the prognosis becomes exceedingly 
grave, for death is the usual result. General wasting palsy 
differs also from the partial variety, not merely in the extent 
and character of its ravages, but in its course and condition of 
origin ; so that there is good reason, apart from the contrasted 
prognosis, to consider the two groups as distinct varieties." 
This must not be confounded with the wasting or atrophy 
resulting from disease of the brain and spinal cord, for though 
we speak of wasting in hemiplegia and paraplegia, it has 
reference to imperfect nutrition from want of innervation 
and proper circulation of blood. 

Shaking Palsy. — Shaking palsy or muscular tremor, bears 
a distant relation to other forms of paralysis, and though not 
unfrequently met with, it has been imperfectly described. It 
occurs most frequently in the declension of life, and must not 
be confounded with chorea, or the muscular tremor of the 
young. Frequently its origin can be dated to some intense 
emotional excitement, or low febrile or inflammatory disease. 
It may affect a single limb or part, or it may be general. The 
head and upper extremities are its most frequent seat, and it 
usually not only increases in intensity as time progresses, but 
extends to adjacent parts. The affection commences at first 
with a feeling of weakness, and difficulty in making the 
muscles obey the will, and more or less agitation when they 
are moved suddenly. It increases gradually, until the parts 
are thrown into violent agitation whenever they are moved, 
and in some cases can not be kept still, the exertion of trying 
to still them only increasing the difficulty. When the lower 
extremities are involved, it is with difficulty that the patient 
walks, and if in the least excited, there is a tendency to fall 
forward, which is only controlled by running. In all cases 
we notice that there is less tremor after rest, and when the 



484 The Eclectic Peactice oe Medicine. 

person's mind is calm and collected, so that in the morning, 
after a good night's rest, the muscles can be controlled by the 
will to a considerable extent. In very severe cases the patient 
so loses control over himself that the most common offices 
have to be performed for him by others. 

Diagnosis. — The diagnosis of paralysis is usually very easy, 
the symptoms being so prominent in most cases that no person 
can make a mistake. So, also, is it very easy to distinguish 
the different forms of it; hemiplegia or paralysis of half the 
body vertically, paraplegia or paralysis of the lower portion 
of the body, transversely, and local paralysis. Hemiplegia we 
have already seen, is produced by disease of the brain, except 
in those rare cases in which it arises from disease of the upper 
portion of the spinal cord, or those which are produced from 
reflex irritation or disease. Paraplegia results from disease of 
the spinal cord or its envelops, except in those cases of reflex 
paralysis already named. Local paralysis may occasionally 
result from disease of the brain, as in some forms of facial 
paralysis, but more frequently from disease of the nerves, or 
parts adjacent to them, or as Dr. Drown-Sequard states, the 
result of reflex irritation. As regards the pathological lesions 
we will have to be guided in our diagnosis by the preceding 
history of the case, and by the present symptoms, it being a 
very difficult matter in many cases. 

Prognosis. — The prognosis in paralysis will depend very 
much upon the character of the lesion. In some cases we 
have good reason to know that the parts are irremediably 
impaired, and in such cases, treatment is of no avail. In 
others, even though the symptoms may be grave, the patient 
may completely recover, and if the paralysis is not complete, 
and there are no evidences showing that disease of the ner- 
vous centers is progressing, the prognosis is favorable. We 
may also give a favorable prognosis in cases in which there is 
amendment, so as to give slight motion and sensation, though 
sometimes we will be mistaken. Rigidity of the paralyzed 
muscles indicates that there is still irritation of the nervous 
center, at the seat of lesion, and that the nerves are capable 
of performing their function, and may be considered favora- 
ble if there is no disturbance of the general system and the 
mind is clear. In cases where the temperature of the part is 
lowered, and there is imperfect circulation, the prognosis is 



Paralysis. 485 

unfavorable, and especially if attended with marked atrophy 
of the muscles. 

Treatment. — The treatment of paralysis is almost wholly 
empirical, and not in that sense that we speak of the empiri- 
cal use of a remedy, which is used simply because it has had 
the desired effect in previous cases, for in this case we can not 
frequently determine whether we have the similar case, and if 
we have, the remedy sometimes proves useless. If the attack 
is recent, and there is evidence of irritation and determination 
of blood as manifested by pain, tenderness on pressure, and 
contraction of muscles, we would adopt means to relieve this 
condition. Wet cups to the part, followed by the irritating 
plaster, an active cathartic of Podophyllin and Leptandrin, 
and a solution of Acetate of Potassa with Tincture of Ascle- 
pias, would be an appropriate treatment. I recollect one case, 
some three years ago, in which hemiplegia followed apo- 
plexy; there was pain in the head, tenderness about the left 
mastoid process, and marked rigidity of the muscles of the 
paralyzed part; he had been treated for three weeks with 
Nux Vomica and Electricity, but grew worse instead of bet- 
ter. He was a stout plethoric man, and I directed eight wet 
cups to the neck as near as possible to the apparent seat of 
the disease, shaved the part and applied a blister two inches 
square, following it with the irritating plaster; evacuated the 
bowels thoroughly with Podophyllin and Bi-tartrate of 
Potassa, and a small portion of Tincture of Aconite; marked 
improvement was noticed the succeeding day, and by the 
sixth day the cure was complete. In some cases of 
hemiplegia, I should administer an emetic, for its revulsive 
influence, but they should be carefully selected. We might 
also use the hot bath, vapor bath, or wet sheet pack, as well 
as the cold douche, in appropriate cases. 

In some cases of hemiplegia and many of paraplegia, there 
has been effusion of blood or coagulable lymph in the ner- 
vous structures, or their membranes, and in consequence of 
absorption there is slow return of sensation and motion. In 
these cases we may employ alteratives with advantage. The 
Compound Tincture of Corydalis with Iodide of Potassium, 
or the Compound Syrup of Stillingia with the same, or 
Bromide of Potassium, may be employed with advantage. 
The Iodide of Ammonium may also be used in doses of five 
grains three or four times a day. Continued suppuration 



486 The Eclectic Practice of Medicine. 

with the irritating plaster is very important, especially in cases 
of disease of the spinal cord. In such cases as these, we 
sometimes obtain more benefit from continuous counter-irri- 
tation, than from all other means put together. If we employ 
cathartics to a considerable extent, as in the case of the con- 
tinuous use of small doses of Podophyllin, it should be associ- 
ated with tonics, as the Quinia and Hydrastin. 

The measures already referred to may be employed with 
equal advantage in both hemiplegia and paraplegia, but fur- 
ther than this we will have to make a distinction. In some 
cases we prefer to let time effect the cure, by the removal of a 
deposit, or the restoration of diseased nervous structure ; our 
attention being directed to keeping the general health in the 
best possible condition, and using means to prevent atrophy 
of the muscles. In such cases we keep the bowels regular 
and the appetite good by the use of the pill, #, Podophyllin, 
gr. xx ; Extract of ISTux Vomica, gr. xv; Quinia, Hydrastin, 
aa, 3ij; M., and make one hundred pills, of which one may 
be taken four times a day. The kidneys may be kept acting 
freely by the employment of a weak solution of Acetate of 
Potassa, and Hydrochlorate of Ammonia, 3j, of each to 
"Water, 3iv. In addition, friction with the hand, or with 
the flesh brush, or the local application of the Tincture of 
Cajeput, or the use of Electricity, with motion as hereafter 
named, will fulfill the indications. There are cases in which 
we would give stimulants freely, Cod-liver Oil, the Hypophos- 
phites or Phosphorated Oil, Quinia, and all those means that 
are known to improve nutrition and favorably influence the 
nervous system. The means recommended in paraplegia 
may also be adopted in some cases, as those already named 
are applicable in a large majority of cases of spinal palsy. 

In paraplegia, and in many cases of hemiplegia and in local 
paral}'sis, Nux Vomica and Strychnia are resorted to more 
frequently and with better success than any other remedies. 
It is the most powerful stimulant of the nervous system we 
possess, and undoubtedly increases the amount of blood 
in the nerve substance and its surroundings, and the vital 
properties of the nervous centers. This being the action of 
the remedy, we would employ it in cases in which there was 
no evidence of irritation, but rather of imperfect circulation 
and nutrition. Belladonna has been highly recommended in 
paralysis by some continental physicians, and though often 



Paralysis. 487 

unsuccessful here, it may depend more upon our want of skill 
in selecting cases, than upon the inertness of the remedy. 

Dr. Brown-Sequard states that: 1st. Belladonna is one of 
the most powerful and reliable remedies that we may employ, 
in cases of paraplegia, with symptoms of irritation of the 
motor, sensitive, and vaso-motor or nutritive nerve fibres, of 
the spinal cord, or of the roots of its nerves; in other words, 
in cases of congestion, meningitis, or myelitis. 2d. Bella- 
donna is a most dangerous agent, able only to increase the 
paralysis, if employed in paraplegia, without symptoms of 
irritation, such as cases of white softening, or of the reflex 
paraplegia. 

Ergot has been used with advantage in some cases of both 
paraplegia and hemiplegia, but more especially the first. It 
is especially indicated in the same cases as the Belladonna, in 
which there is congestion or irritation of the spinal cord, and 
should be avoided in cases without irritation, as in reflex para- 
plegia and softening. Sulphur and Phosphorus may both be 
employed with advantage in cases of softening of the spinal 
cord, or where there is evidence of feeble nutrition. Cod- 
liver Oil, Quinia, Iron, and the bitter tonics will occasionally 
prove very serviceable in the last named cases, and sometimes 
in all forms of the disease. Cantharides, Rhus Toxicoden- 
dron, Lachesis and Bryonia, act in a very similar manner to 
Strychnia, and Stramonium, Hyoscyamus and Indian Hemp, 
to Belladonna. 

As heretofore remarked, we obtain great advantage in cases 
of paraplegia, with symptoms of irritation of the diseased 
portion of the spinal cord, from the use of counter-irritation. 
In the majority of cases we use the irritating plaster, in some 
the dry cups, in others firing, and in others the seton, issue, etc. 
The hot douche to the spine is sometimes efficacious, but the 
cases must be carefully selected. Suppuration is the end 
desired in a majority of cases, and any application that will 
continue it without endangering the tissues will prove the 
best. In the opposite class of cases, we would use stimulant 
applications and friction to induce determination of blood. 
Compound Tincture of Cajeput answers a good purpose, and 
the salt water friction may be employed. The cold douche 
to the part of the spine affected, is sometimes useful, but it 
must be employed for reaction rather than for its immediate 
influence. If circulation is feeble in the paralyzed part, we 



488 The Eclectic Practice of Medicine. 

would direct frictions, with the use of a stimulant, as the 
Tincture of Capsicum in such strength as was necessary. 
This is especially indicated where nutrition of the part is 
impaired, as is manifest by gradual atrophy; and in this case, 
in addition to the friction, we would move the extremities in 
various ways to call into action the muscles. Electricity is of 
much advantage in these cases, not because it removes the 
paralysis, but because by it we can call the muscles into 
action, and stimulate normal circulation of blood and nutri- 
tion. We employ Electricity as a curative agent in some 
cases, passing the current from the part of the nervous cen- 
ter paralyzed through the body in the direction of the nerves, 
or in some cases confining it to the nervous center alone, as 
in cases of paraplegia from disease of the spine. 

Shaking palsy if of long duration is not only incurable, but 
does not usually admit of amelioration. In some acute cases, 
arising from arrest of secretion, the proper use of purgatives 
and diaphoretics may be successful. "Wasting palsy demands 
considerable care and attention. The patient should be put 
upon the use of Cod-liver Oil, the bitter tonics and Iron, 
should have abundant exercise in the open air, and a highly 
nutritious diet. In addition, galvanism should be applied 
every day, for ten or fifteen minutes at a sitting: it is not 
used as in previous cases — passing the current from the spine 
in the direction of the nerve trunks — but the poles of the 
battery being covered with wet sponge, they are placed on the 
affected muscle a short distance apart, and by moving, the 
entire structure is influenced, which increases the advantage 
of the application: those parts that have suffered most should 
receive the most attention, but it should not be continued too 
long. 



CEPHALALGIA. 

Headache is one of the most common forms of disease that 
we meet with, and though generally considered as but a slight 
affection, there is none probably that occasions more suffer- 
ing, or that is less amenable to the usual treatment. It would 
seem, from the extent of information on this subject among 
medical men, that it was hardly worthy of notice, and had 
better be left as a matter of family practice, or as a disease 
for patent medicines. The causes of headache are very many, 



Cephalalgia. 489 

and though we can not possibly tell why they produce this 
affection, or even what structure it is that is painful, we are 
enabled by studying them to relieve the pain in nearly all 
cases, and to effect permanent cures in a great mauy. 

We might group the different kinds of headache under the 
following forms: 1st. Headache from determination of blood. 
2d. From cold. 3d. From depression or exhaustion. 4th. 
From derangement of the stomach, liver, etc. 5th. Pericran- 
ial or from disease of the pericranium, or cranial bones. 6th. 
From deficient urinary excretion. 7th. From rheumatism. 
8th. Periodical, from malaria; and 9th. The sympathetic. 
It is true that we can not always make these distinctions, and 
that two or more of them may be associated together, but as 
giving a general idea of the disease, the divisions are useful. 

Headache from determination of. blood, is a frequent form of 
the disease, and may arise from any cause producing irritation 
of the brain, as, over-excitement, severe exercise in a stooping 
position, or in the sun, etc.; or from arrest of secretion, the 
blood vessels being overloaded in consequence. The same 
causes will give rise to a slight congestion of the head, and 
may be considered as similar in character to determination. 
The symptoms of this form of headache are, intense aching 
pain in the head of a tensive or throbbing character, the head 
is hot, the face Hushed, the eyes suffused and intolerant of 
light, and the secretions are more or less arrested. It usually 
passes off' in twenty-four or forty-eight hours, but may con- 
tinue for several days. Some persons seem subject to it, and 
have attacks from slight causes. 

In mauy cases of this form of headache we would give a 
brisk purgative, as the Compound Podophyllin Pill, in the 
meantime using the Tincture of Gelseminum to modify the 
fever. If the pain is excessive, we may use the hot foot bath 
and give the patient some warm diaphoretic infusion, or, #, 
Essl. Tincture of Asclepias, f3ij; Tincture of Gelseminum, 
f3ss; in doses of a teaspoonful every hour until free perspira- 
ration is produced. "When the person is subject to frequent 
attacks of such headache, we may recommend that particular 
attention be paid to keeping the bowels regular, that a daily 
cold bath be used, if possible, and if persistent, we may pre- 
scribe, #, Acetate of Potassa, 5ss; Tincture of Gelseminum, 
3ss; Aqua, fS'yss; M., and take in teaspoonful doses, three or 
four times a day. 



490 The Eclectic Practice of Medicine. 

Headache from cold is a frequent form of the disease in 
winter and spring, and will sometimes last for several days at 
a time. It seems to be dependent partially upon arrest of 
secretion, but more especially upon the sub-inflammatory 
condition of the mucous membrane of the nose, pharynx, etc. 
The head feels full and heavy, and the pain is usually dull and 
aching, with occasional sharp, darting pains just above the 
eyes, especially on stooping, or any continual mental exertion. 

We would treat this case as we would the bad cold it is 
associated with. The feet should be bathed in hot Mustard 
water, the patient packed warmly in bed, and an active 
diaphoretic used to induce free perspiration. A purgative 
may frequently be used with advantage, and sometimes the 
speediest relief is obtained from the use of an emetic. Tinc- 
ture of Gelseminum, in doses often to thirty drops every two 
or three hours, is a valuable remedy in many cases, and an 
alkaline diuretic should follow the diaphoretic. Frequently 
we would direct a sinapism to the back of the neck and 
between the shoulders, and occasionally in severe cases we 
may use the cups. 

Headache is of frequent occurrence in anaemic conditions of 
the system, and is sometimes the most troublesome symptom; 
in other cases the head is perfectly clear and free from pain. 
We suppose that the headache in these cases is owing to 
feeble circulation in the brain and imperfect nutrition, though 
in many cases, even here, it will be found to depend upon 
derangement of the stomach and arrest of secretion. Head- 
ache from temporary exhaustion from excessive physical or 
mental exercise, or emotional excitement, is of very frequent 
occurrence, and is usually very severe and attended with 
derangement of the stomach, and hence forms one variety of 
sick headache. In both these cases the pain is sharp and 
acute, darting, tearing, tensive, and throbbing, and the 
patient suffers severely. Usually the face is pallid and con- 
tracted, the eyes sunk in the head, a dark line around or 
under them, and a weary, anxious expression of countenance. 
It may last but one day, or it may continue for several, and 
may recur frequently. 

If in this case the secretions are deranged, we find that it is 
necessary to restore them before the headache can be con- 
trolled; hence the advantage of mild stimulant purgatives, 
diaphoretics, and alkaline diuretics. When the tongue is 



Cephalalgia. 491 

coated, a bad taste in the mouth, and sickness of the stomach, 
the headache being persistent, a mild emetic will usually give 
speedy relief. For the attack I frequently prescribe, #, Essl. 
Tincture of Asclepias, 3ij; Tincture of Valerian, 3j; M., and 
give in half teaspoonful or teaspoonful doses every hour or 
two, the patient lying down and keeping perfectly quiet. A 
sinapism to the back of the neck, and to the epigastrium, 
sometimes gives marked relief. When there is a general 
anaemic condition, the permanent cure will depend upon the 
restoration of a normal quantity and quality of the blood ; 
]Sux Vomica or Strychnia, Sulphur and some preparation of 
Phosphorus, being important agents in the cure. 

Pericranial headache is not of frequent occurrence, though 
occasionally a case is met with. It is said to occur only in 
those who have suffered from continued cerebral excitement, 
and that it depends upon a highly vascular state of the brain 
and membranes. It is caused by cold, by sudden changes of 
temperature, by excitement of the brain from long-continued 
study or emotional excitement. The pain is tensive and 
remitting, and is increased by pressure, or by moving the 
muscles of the scalp. The patient is restless and uneasy, 
sleeps poorly at night, has bad dreams and startings in his 
sleep. It may last for several weeks, or even months, being 
better when the weather is fair, and the patient calm and 
quiet, but aggravated by excitement, by change of weather, 
or exposure to a draught of cold or damp air. Disease of 
the bones of the cranium giving rise to headache, is most 
generally syphilitic, as in most other cases no disturbance of 
the brain is produced. The pain is localized and remittent, 
occurring more frequently and with greater severity at night. 

In the first case we should recommend perfect quiet so far 
as mental exertion or excitement is concerned, the patient 
taking as much physical exercise in the open air as seems ben- 
eficial. The bowels may be kept open with the Podophyllin 
pill, the urinary secretion free, by the use of alkaline diuretics, 
and the condition of the skin improved by the use of the Salt 
water bath with friction. In some cases w T e may accomplish 
all that we desire with medicine by the use of the Compound 
Tincture of Corydalis and Iodide of Potassium, with some- 
times the addition of a portion of the Essl. Tincture of 
Jeffersonia. The Iodide of Ammonium, in doses of from three 
to five grains four times a day, answers a good purpose in 



492 The Eclectic Practice of Medicine. 

cases of cerebral excitement, and especially on those in which 
there is temporary forgetfulness and dizziness following the 
preceding condition. In disease of the cranial bones we 
would adopt an anti-syphilitic treatment if the case was in 
any degree obscure, and we might so arrange it as to relieve 
the pain at the same time we were counteracting the specific 
disease ; as, #, Extract of Conium, 3j ; Iodide of Potassa, 3ij ; 
Tincture of Macrotys, Tincture of Corydalis, aa, f3ss; Aqua> 
f3iij ; M., and give in teaspoonful doses three times a day. 

Headache from deficient action of the kidneys,ia in my opinion, 
the most common form of the disease. It is occasioned by cold 
or any cause that tends to arrest the secretion. In some per- 
sons it recurs frequently, and lasts for one or two days at a 
time, so as to become a source of great anno}'ance. In the 
milder cases the head feels heavy and dull, and there is a dull, 
aching pain and feeling of soreness in the base of the cranium, 
sometimes shooting from side to side, and at others from 
before backward. In severe attacks, the pain is intense, dar- 
ting, throbbing, and tensive, and is aggravated by motion, 
and especially by noise, or stooping. If attention is called to it, 
it will be noticed that the urine was scanty prior to the attack, 
and became more free afterwards. 

"We can mitigate this form of the disease by the administra- 
tion of purgatives and diaphoretics, but it is more readily 
arrested by the use of the saline diuretics. The tendency to 
the disease maybe frequently overcome by the employment of 
a solution of Acetate of Potassa in the usual doses, whenever 
the head commences to feel heavy and bad. 

Derangement of the stomach is a frequent cause of headache, 
and especially in persons of sedentary habits, and those who 
have but little exercise in the open air. It is noticed in these 
cases that the susceptibility of the nervous system is increased, 
and the digestive and assimilative functions weakened. This 
form of headache is induced by anything that irritates the 
stomach, as indulgence in improper food, eating late suppers, 
overloading the stomach, too free use of stimulants, especially 
if not accustomed to their use, constipation of the bowels, etc. 
An attack of this headache usually comes on with a sense of 
weight and tension, with dizziness, and a sharp, lancinating 
pain when the patient stoops. In an hour or two the patient 
frequently feels chilly, and there is a sensation of nausea and 
disgust, which not unfrequently terminates in vomiting. The 



Cephalalgia. 493 

pain now becomes severe, is dull, aching and tensive, with 
throbbing- in the temples, and almost insupportable weight ; or 
is sharp and lancinating, darting from one part to another, 
and seeming sometimes as if the head would be torn to pieces 
with its violence. It usually commences in the morning, and 
does not terminate until the patient goes to sleep at night, and 
in rare cases continues for several days. 

If called to a case of this kind of headache during the 
attack, I usually administer an emetic, one that will act 
quickly and kindly being preferred. There is no other way 
to check the paroxysm in a majority of cases, and this is very 
efficient. Otherwise, I would have the feet bathed in hot 
Mustard water, a sinapism applied over the epigastrium, and 
upon the nape of the neck, and give freely an infusion of 
Sage, Spearmint, Pennyroyal, or any warm, stimulating dia- 
phoretic. Quite frequently when the patient has drank a 
cupful, vomiting ensues, and it is thrown up; if it is now 
repeated, in a short time the patient will go to sleep, and will 
awake refreshed. We can generally ward off an attack by the 
use of the jSTeutralizing Cordial, or a mild cathartic taken the 
evening previous, or by the administration of an alkaline 
diuretic. For the radical cure, we will adopt such means as 
would seem indicated from the condition of the stomach, some 
form of dyspepsia being almost always present. 

Rheumatic headache most usually results from cold, espe- 
cially night exposure, or sitting where the cold air will strike 
the face, though sometimes it is observed as a metastasis of 
rheumatism. It may be situate in the muscles, as the occipito- 
frontalis, temporal, or the muscles of the occiput, and back 
of the neck, and is sometimes associated with determination 
to the membranes of the brain. "The pain is severe, heavy, 
distracting, and aching, and in its uncomplicated state is 
attended by a sense of coldness, by great tenderness of the 
scalp, by rheumatic pains, extending down the neck, or in 
one side of the neck, or one shoulder, or in the face ; some- 
times by copious perspiration, and more rarely by rheumatic 
inflammation of one or both eyes. It is generally aggravated 
in the evening, and alleviated in the morning and by warmth. " 
If the membranes of the brain are affected, there is also giddi- 
ness, drowsiness, and internal throbbings, the face being often 
flushed, the eyes injected, and the vessels loaded. 

We would treat rheumatic headache as we would any case 



494 The Eclectic Practice of Medicine. 

of rheumatism, to which the reader is referred for full des- 
cription. Tincture of Macrotys, with Tincture of Asclepias 
and Gelseminum, equal parts, given in teaspoonful doses 
every two or three hours, is often very efficient. We may 
add to it an alkaline diuretic, as the Acetate or Citrate of 
Potassa, or we may use the last named agents alone. Macro- 
tys with Conium forms a good combination, as, #, Extract of 
Conium, 3ss ; Tincture of Macrotys, f3j ; Iodide of Potassa, 
3j ; Water, f3iij ; M., and give in teaspoonful doses every 
three hours. Cups to the nape of the neck, followed by the 
irritating plaster, is the most useful local application. 

Headache is frequently periodic, and is occasioned we sup- 
pose by the same causes that give rise to other periodic 
diseases. In the most frequent form, it comes on in the 
morning, and gradually increases up to noon, and then 
decreases until evening. It may, however, appear at any 
period of the day, or every other, or every third day. The 
pain is sometimes dull, heavy, and contusive, and at others 
sharp, lancinating, and throbbing; there may or may not be 
sickness of the stomach, or chilly sensations, or slight febrile 
action when the pain is most intense. 

In periodic headache we wish first to establish the secre- 
tions, which are almost always impaired, and next to adminis- 
ter some remedy capable of controlling the periodicity. Thus, 
if the bowels were costive we would give a Podophyllin 
purgative, with a diaphoretic, as, Essl. Tincture of Asclepias 
and Eupatorium, with Tincture of Gelseminum, and an alka- 
line diuretic. In some cases this will control the headache, 
but usually it only prepares the way for the administration of 
Quinia, which is given in the same doses that would be used 
in a case of ague. Given in this wa} r , Quinia always arrests 
the disease, but if the system is not properly prepared for it 
it frequently fails. 

Sympathetic headache is sometimes called nervous, and gen- 
erally occurs in feeble, debilitated persons, and those of a 
sedentary habit. It is almost always associated with diseases 
of some other part of the body, and is thus frequently seen 
in cases of uterine disease, especially functional lesions, in 
derangements of the urino-genital organs, the bowels, etc. 
The pain varies in character, resembling the two preceding 
forms, and recurs frequently but at irregular periods. 

Having determined the nature of the lesion giving rise to 



Cephalalgia. 495 

the headache, we will frequently relieve it either by curing 
or palliating the primary disease. Any of the means already 
named may be employed in addition. The Jeffersonia has 
been strongly recommended in this and analogous cases, 
and is well worthy of trial. Liquor Ammonia is used with 
advantage in this and some other forms of headache ; twenty 
to forty drops may be thoroughly mixed with a cup of gruel, 
and taken at bedtime, or whenever the paroxysm of pain 
occurs. Dr. Simpson recommended the Sulphate of Nickel 
in doses of from half to one grain three times a day, and it 
seemed to be of more service in chlorosis and amenorrhea. 



496 The Eclectic Practice of Medicine. 



CHAPTER VIII. 

DISEASES OF THE ORGANS OF SPECIAL SEISTSE. 

These affections are of very frequent occurrence, and except 
from special treatises the practitioner lias no means of refer- 
ence, as they are but partially described in works on practice 
and surgery. For some years past the treatment of diseases 
of the eye and ear have been made a speciality ; and they 
have been so divided and subdivided, and so many long 
names affixed to small things, that the general practitioner 
lias great difficulty in understanding a technical work on the 
subject. There can be no doubt but that these diseases can 
be better treated by the specialist than by the general practi- 
tioner, and yet many times it is impossible for the patient to get 
other treatment than from the family physician. This fact, if no 
other reasons existed, should cause us to study these diseases 
with that care that will enable us to diagnose their various 
phases, and treat promptly and successfully those that are 
amenable to medicine, reserving those cases for the oculist 
that require surgical interference. While, therefore, I shall 
be compelled to be brief in my description, I will try to place 
it in such a light that it will be readily understood. ' 



DISEASES OF THE EYE. 

The eye is one of the most important organs of the body, 
and though its diseases do not endanger life, their favorable 
termination is as anxiously watched for by both patient and 
friends as the more grave maladies. As regards the pathology 
of these affections, we will find it the same as in other por- 
tions of the body, and as a general rule, the same treatment 
will be applicable. Inflammation of the structures of the eye is 
the same disease as inflammation of any other part of the body, 
differing only as regards the peculiarity of structure and func- 
tion of the parts. And in the treatment of this affection the 
same general principles apply in the one case as in the other. 



Diseases of the Eye. 497 

So it is in all other diseases, and he who properly understands 
the pathology and nature of the affection need be at no loss 
for appropriate treatment. 

The organ of sight, it will be recollected, consists of two 
parts, the eye itself and its appendages, the latter being two 
palpebra or lids, the conjunctiva or investing membrane, the 
lachrymal apparatus, the muscles moving the eye, and the cel- 
lular and adipose tissue that forms its bed. Each of these 
parts may be diseased, but some of them so rarely that it is 
hardly worth while to notice them in this place. The globe 
of the eye is composed of three tunics, the external composed 
of the sclerotic and cornea, the middle of the choroid, and the 
internal the retina or expansion of the optic nerve; it has a 
muscular septum dividing it into two parts; the iris; and has 
three humors possessing different degrees of density, the aque- 
ous, the vitreous, and the crystaline lens. 

The eyelids may be the subject of phlegmonous inflam- 
mation, usualty associated with erysipelas. They are swollen 
and livid, and very painful, and occasionally the inflam- 
mation extends to the cellular tissue of the orbit. It may 
terminate in resolution or suppuration, the pain being severe 
and throbbing when pus has formed, and the constitutional 
symptoms tolerably well marked. If the inflammation is 
dependent upon erysipelas, we may apply equal parts of 
Tincture of Muriate of Iron and Glycerin, every two or three 
hours, keeping a cloth wet with the same over it; if from 
other causes, a poultice of equal parts of Hydrastis and 
Ulmus, or cloths dipped in a decoction of Cornus, with a 
small portion of Tincture of Aconite. The bowels may be 
moved with the Compound Powder of Jalap and Senna, and 
if necessary a diaphoretic and diuretic given. If suppuration 
occurs, the abscess should be carefully opened as soon as it is 
detected, as if it remains it increases in size, and sometimes 
causes great destruction. 

Furuncle, or boils of the eyelid, are of very frequent occur- 
rence, and sometimes occasion much suffering. Occasionally 
they pass through their stages rapidly, a week sufficing for 
their removal, but in other cases they are very chronic. 
When formed on the edge of the eyelid, they are called styes, 
and are smaller but not less painful. They require but little 
attention, except in such cases as would be injured by the 
continued pain and restlessness produced by them. In such 
32 



498 The Eclectic Practice of Medicine. 

cases they may be incised, and if pus has not yet formed, 
touched freely with a crystal of Sulphate of Zinc, and a poul- 
tice applied. 

Ptosis, or falling of the upper eyelid, is caused by paralysis 
of the third pair of nerves, or by disease affecting the eyelid, 
or the levator muscle. In cases of paralysis, it may be relieved 
sometimes by the use of Electricity or local stimulant appli- 
cations and the proper internal remedies; failing in this, and 
in the cases not dependent upon paralysis, a surgical operation 
is demanded. Entr opium or inversion of the eyelids, and ectro- 
pium or eversion, are only remediable by surgical operations. 

Trichiasis, or inversion of the eyelashes, is popularly known 
as "wild hairs in the eye," and is often a source of great irri- 
tation, if not of inflammation. The trouble is owing to a mis- 
direction of the cilia, a portion of them being turned inwards, 
so as to come in contact with the eye. The cause is usually 
easily detected by turning the patient's eye to a strong light 
and slightly raising the lid, the faulty hairs being seen to pass 
inwards to the conjunctiva. They are usually of a light color, 
smaller and much more flexible than the normal ones, and for 
these reasons are sometimes detected with difficulty. In cases 
of partial trichiasis the treatment is easy, and consists simply 
in removing the offending cilia with a pair of forceps. I can 
yet feel the mortification I once experienced, in which, after 
treating a case of a sore eyes" for two weeks, the patient was 
cured in forty-eight hours by an old woman removing these 
faulty hairs. In severe cases this will not answer, a surgical 
operation being necessary. 



OPHTHALMIA TARSI. 

Inflammation of the edges of the eyelids is noticed more 
frequently in children than in the adult, and is frequently 
associated witlr some depraved habit of bod\ r , as scrofula. 
When primary, it may be the result of cold, smoke, impure 
air, and filthiness; but it is most usually a sequence of 
catarrhal ophthalmia or scrofulous conjunctivitis. The disease 
is located in the edge of the lid and meibomian follicles, and 
in many cases so affects the roots of the eyelashes as to cause 
them to fall out, hence that appearance termed "blear-eyes." 
The eyes look sore and tumid, and the patient complains of a 
sensation of roughness, and as if there was sand in the eye, 



Ophthalmia Tarsi. 499 

when the lids are moved, and thns there is the constant ten- 
dency to keep them partially closed. They are agglutinated 
together in the morning, sometimes so much so that the 
patient has to soften them before he can open them, and it is 
even then attended with pain. Ophthalmia tarsi is essentially 
a chronic affection, with but little tendency to spontaneous 
recovery, and is sometimes very difficult to cure, and if the 
meibomian glands are closed, the edge of the lid has a 
shining, glistening appearance. 

Treatment. — As there is almost always a faulty constitu- 
tion, with marked evidence of some cachexia, we find it 
important to put the patient upon an alterative and tonic 
course of treatment. The Compound Tincture of Corydalis, 
or Compound Syrup of Stillingia, with Iodide of Potassium, 
may be administered in the usual doses. Some preparation 
of Iron should be given with this, frequently the Tincture of 
Muriate of Iron will answer best; and if necessary, the bitter 
.tonics may be added. Yery much depends upon keeping the 
eyes clean, and removing the tenacious secretion without 
causing pain and irritation. Hence, the eyes should be fre- 
quently bathed during the day with warm water, or a weak 
decoction of Cornus or Hydrastis, keeping them as entirely 
free from the secretion as possible. Glycerin answers a very 
good purpose in some cases, usually combined with an equal 
quantity of Rose- Water, and applied freely. The parts being 
perfectly cleansed, we apply once or twice daily, a very small 
portion of mild Zinc or Ophthalmic Ointment; or, instead of 
this, we may use a mild colly rium of Sulphate of Zinc or 
Borax, or one or two drachms of Nitrous ^Ether and Vinegar 
in eight ounces of water, and followed by the Glycerin lotion. 
In very severe cases, the faulty cilia may be removed, the 
crusts carefully taken off, and the ulcers lightly touched with 
Nitrate of Silver. In the application of warm water, or the 
decoctions named, or to foment the eye, we can accomplish 
our purpose best by the use of a very soft sponge. Counter- 
irritation to the nape of the neck, or behind or before the 
ears, with the blister or irritating plaster, is often of great 
advantage. 



500 The Eclectic Practice of Medicine, 



CATARRHAL CONJUNCTIVITIS. 

The conjunctiva covering in the globe of the eye, and lining 
the lids is exquisitely sensitive, and though abundantly pro- 
tected, is frequently exposed to the causes of inflammation. 
Temporary inflammation is often seen as the result of dirt or 
sand in the eye, or even exposure, but very soon disappears 
with rest. The disease we are now describing may arise from 
cold, sudden changes of temperature, extension of inflamma- 
tion from the mucous membrane of the nose, or from inocu- 
lation with the secretion of a diseased eye. This last cause 
should be carefully guarded against, as we not unfrequently 
observe whole families attacked with the disease from the 
indiscriminate use of towels. 

Symptoms. — The disease commences with a sensation of dr} r - 
ness and smarting of the eyelids, with a feeling as if dirt or 
sand had got into the eye, and it is with difficulty that the 
patient gives up this idea, the impression is so strong. In a 
short time the eyes seem tumid and swollen, the unpleasant 
sensations have increased, and a more or less abundant secre- 
tion, sometimes opaque and puriform, is established. If the 
eyes are now examined, the palpebral conjunctiva will be 
found red and swollen, and more or less reticular redness of 
the ocular conjunctiva. As the inflammation progresses, the 
last portion of the conjunctiva becomes more completely 
involved, and we sometimes observe ecchymosis or extrava- 
sated blood under it. In a still severer form the conjunc- 
tiva is remarkably injected and swollen to the point where 
it passes into the cornea, so much so occasionally as to par- 
tially cover up this part of the eye; this swelling is' termed che- 
mosis. Catarrhal ophthalmia is always periodic, the exacer- 
bation occurring in the evening, and sometimes attended with 
headache, the pain and itchiness cease a short time after going 
to bed, and the patient sleeps well, but it reappears in the 
morning on attempting to use the eyes. 

In many cases the disease continues thus for a week or ten 
days, and then gets well without further change ; but in some 
cases it is more persistent. Sometimes we notice a small blis- 
ter on the ocular conjunctiva, which rupturing forms an ulcer, 
constantly throwing off an abundant puriform secretion ; it 
may attain the size of a half-dime, or be even larger than this, 



Catarrhal Conjunctivitis. 501 

and is usually very painful. The cornea is sometimes obscured 
and hazy from the inflammation, and in that variety of the 
disease termed phlyctenular has a tendency to ulcerate. This 
last form of the disease occurs most frequently in children and 
young persons, and is usually connected with a scrofulous 
constitution. The symptoms are, marked pain and intoler- 
ance of light, free secretion of tears, deep redness of the 
eyelids, but slight of the ocular conjunctiva, sometimes but 
three or four vessels being seen to pass across to the cornea. 
Soon we notice the production of one or more blisters on 
the cornea, which discharging, forms an ulcer; this may 
increase in size until it involves a considerable portion of the 
cornea, or it may rapidly increase in depth until it perforates 
it, and causes a discharge of the aqueous humor. In 
some of these eases, the phlyctenula are absorbed, leaving a 
small, white spot, called albugo ; or a cicatrice results from 
the ulceration, called leweoma. If the ulcer penetrates the 
cornea, the iris is almost always thrown forward by the escape 
of the aqueous humor, and passing into the opening becomes 
adherent^ and is termed syneekia anterior. 

Diagnosis. — Catarrhal conjunctivitis is usually recognized 
with ease ; the inflammatory action commencing in the palpe- 
bral conjunctiva, and subsequently extending to the ocular 
portion, with secretion of muco-pus, are the characteristic 
symptoms. In phlyctenular ophthalmia, there is inflamma- 
tion of the conjunctiva, but the disease is principally eonfined 
to the cornea ; the appearance of the small vesicles or ulcers 
in the cornea marks the distinction- That form described 
as pustular, is marked by the formation of pustules, termina- 
ting in ulcers in the ocular conjunctiva, near the cornea. 

Prognosis. — In the milder forms of catarrhal ophthalmia we 
usually succeed in arresting the disease in a week or ten days, 
but if allowed to progress, or badly treated, it may endanger 
the integrity of the eye and last for months. The phlyctenu- 
lar form is more difficult to treat, and not unfrequently leaves 
the marks already mentioned. Pustular ophthalmia is usu- 
ally very perverse, but with care may be managed so as to 
leave no bad result. Either of these forms may become 
chronic, and develop structural change which will impair vis- 
ion to a greater or less extent. , 

Treatment. — In the first stage of the disease we would 
administer a brisk purgative as a means of derivation, and 



502 The Eclectic Practice of Medicine, 

give some active diaphoretic, and favor its action with the hot 
Mustard foot bath, or in some cases the vapor hath. This 
may he succeeded by an alkaline diuretic if it seems to be 
needed, the diaphoretic being continued, and the cathartic 
repeated if necessary. If the health is feeble this treatment 
should be associated with Quinia and Hydrastin, and if the 
patient is scrofulous, the administration of Cod-liver Oil and 
Whisky. In addition to this we may use counter-irritation to 
the neck, or before or behind the ears, in some cases using 
the irritating plaster, in others small blisters. 

Various collyria are recommended, in fact so many that the 
young practitioner does not know which to select. I usually 
employ, #, Tincture of Belladonna, gtt. xx; Tincture of Gel- 
seminum, 3j ; "Water, gij ; dropping it in the eye every three or 
four hours. Associated with this, if the case is acute, I direct 
that the eye be fomented with hot water, a pieee of very soft 
sponge being used to make the application. In some cases a 
poultice of equal parts of Hydrastis and TTlnms, answers a 
goed purpose, bvA I now prefer the fomentation. In all cases 
the patient should be kept perfectly still, in a darkened room,, 
and use a light and easily digested diet. Mackenzie strongly 
recommends the use of a solution of Nitrate of Silver, gr. iv, 
to Water, 3j ; a large drop being applied to the eye two or 
three times daify. For a few miniates the eye feels easy, and 
then for ten minutes there is a sharp pricking pain, which 
subsiding leaves the eye almost wholly free from pain for five 
or six hours, when the application should be repeated. Dr. 
Williams recommends ,a solution of Sulphate of Zinc in Rose- 
water in the proportion of from two to four grains to the 
ounce. 

In phlyctenular or pustular ophthalmia, I employ a cathartic 
and tonic combined, as, #, Podophyllin, gr. xv; Quinia, 
Hydrastin, Leptandrin, aa, 3j ; M., and make sixty pills or 
powders, of which one may be given four or five times a day. 
Associated with this, I have used the Compound Tincture of 
Corydalis, the Compound Syrup of Stillingia, and in some 
cases Cod-liver Oil. Sulphate of Beeberina, with Carbonate 
of Ammonia, answers a good purpose, as does also, the 
majority of the bitter tonics. If the tongue is coated at the 
base, with a feeling of great languor, nothing will prove more 
speedily or permanently beneficial than a thorough emetic, 
occasionally followed with the warm bath, The preparations 



Purulent Conjunctivitis. 503 

of Iron are frequently useful, and may be occasionally associ- 
ated with the Hypophosphites and with Sulphur. 

In the early stage of the disease we might steam the eye 
with hot water and Belladonna, 3ss of the tincture to'giv of 
water, three or four times a day, and use the Belladonna and 
Gelseminum lotion heretofore named. If the pain is very 
severe, we may use hot fomentations, and if these can not be 
properly applied, we may paint around the eyes and the eye- 
lids with Tincture of Iodine every two or three days. Many 
practitioners use the Collyrium of Nitrate of Silver heretofore 
mentioned, and some employ a solution of Sulphate of Zinc. 
The treatment of the chronic form of the disease will be 
hereafter considered. 



PURULENT CONJUNCTIVITIS. 

purulent conjunctivitis, or Egyptian ophthalmia, is not of 
frequent occurrence in this country, though when met with 
there are generally several cases, -as it is very contagious. It 
frequently affects one eye at a time, but both may be involved. 
It commences with an itching and feeling as if there were 
particles of dirt in the eye, and adhesion of the lids in the 
morning. In the course of one or two days this itching has 
become very severe, and is attended with a smarting, burning 
pain, and the discharge of a thin, acrid fluid from the eye, 
which runs over the lid and produces smarting. Oji everting 
the lids we find the conjunctiva swollen and reddened, and 
usually but slight symptoms of inflammation of the ocular 
conjunctiva. As the disease progresses, the secretion becomes 
thicker and purulent, and is still acrid or irritating; the 
patient feels very markedly the sensation as if sand was in the 
eye, though the pain is not increased by exposure to light. In 
some cases the ocular conjunctiva is quickly involved, and 
there is free effusion into the areolar tissue; there is marked 
chemosis, which occasionally almost buries the cornea. The 
chemosis sometimes extends to the lids, which become very 
much swollen, and the mucous membrane being everted it 
presents a very alarming appearance. 

The purulent secretion continuing for twelve or fourteen 
days, diminishes in quantity and is less acrid, and on examin- 
ation we find that the chemosis and redness are disappearing, 
and the patient can- make use of his eyes, though they are 



504 The Eclectic Practice of Medicine. 

still weak; this we would call a favorable termination. In 
other cases the inflammation is more severe, the eyes are 
swollen so that it is impossible to open them, and there is 
occasionally severe pain about the orbit, and over the frontal 
sinuses, and shooting pains through the globe of the eye. For 
days or weeks the eye continues in this condition, throwing 
out an abundant purulent secretion, and when the inflamma- 
tion does subside, we find that it has left most serious lesions. 
Bursting of the cornea, and discharge of the aqueous humor 
is not unfrequent, vision being entirely lost, and the eye in a 
staphylomatous condition. In other cases there is more or 
less opacity of the cornea, obstructing vision, and in the most 
severe cases the cornea gives way and the aqueous humor is 
discharged, and this is followed in a few hours by the crystal- 
ine lens, and a considerable portion of the vitreous humor. 

Diagnosis. — We diagnose this from conjunctivitis, by the 
free purulent secretion, the marked swelling and tumefaction 
of the eyelids, and their stiffness and immobility. There is 
only one form of inflammation that could be mistaken for it, 
and that is gonorrheal ophthalmia, and in this case the diag- 
nosis will in many cases be made easy by the previous history' 
of the case, and the fact that but one eye is involved. 

Prognosis. — " When the inflammation is of an active char- 
acter, and not modified by any constitutional peculiarity, 
early and proper treatment promises success. When the 
inflammation is of a torpid character, and when the constitu- 
tion is scrofulous, it yields less readily to treatment, subsides 
less quickly and perfectly, and fixing itself in the structures of 
the eye is apt to produce degeneration of it. In erethetic irri- 
table cases, the prognosis is also unfavorable, but less so than 
in torpid cases. " — (Jones.) 

Treatment. — In the early stage we would commence the 
treatment with a brisk stimulant purgative, as the Compound 
Powder of Jalap and Senna. The spirit vapor bath, with hot 
pediluvia, may be used, or the general warm bath, with an 
active diaphoretic, as, Compound Powder of Ipecac and Opium 
in doses of five grains every two hours, or teaspoonful doses 
of the Tincture of Asclepias. As soon as secretion becomes 
free, we would give Quinia and Hydrastin freely. The pill 
of Quinia, Hydrastin and Podophyllin is an excellent combi- 
nation in the more chronic cases. 

Dr. Mackenzie remarks that our main dependence will be 



Purulent Conjunctivitis. 505 

on our local remedies, " for if none are employed, or only- 
improper ones, the eyes may be lost, notwithstanding the best 
general treatment. " " It may appear to some paradoxical 
that the local applications in this disease should be alternately 
soothing and stimulating. Were we to trust to either sort 
alone, we should endanger the eyes. Soaking them constant- 
ly with tepid water, or laying emollient cataplasms over them, 
would be almost certain destruction ; and on the other hand a 
perpetual succession of stimulating solutions and salves would 
be no less detrimental. " Perfect cleanliness is of absolute 
importance, and for this purpose the eye should be washed 
two or three times a day with tepid water, and a weak solution 
of Carbonate of Ammonia, or Chlorate of Potassa, say, about 
six grains to the ounce of water. If the lids are so swollen 
that the eye can not be thoroughly cleansed without, we will 
use a syringe, being careful not to injure the structures of the 
eye. Following this, we may use the Tincture of Myrrh in 
its full strength, or diluted with one or two parts of water, or 
instead of this may use a colly rium of Nitrate of Silver, 
from four to eight grains to the ounce of water. Sulphate of 
Zinc, ten or fifteen grains to the ounce of water, has been 
recommended, but I do not like its action. Glycerin alone, 
or as a vehicle for other remedies has an excellent action. Pol- 
lowing the stimulant agents named, we would apply a 
solution of Extract of Belladonna, 3j, to water, Oj ; using it 
as a fomentation or a cold application as was most agreeable 
to the patient. The vapor of Bi-sulphuret of Carbon, say ten 
to twenty drops to an ounce of hot water, the vapor con- 
ducted to the eye by a glass made for the purpose, or a 
temporary paper funnel, answers a good purpose, in place of 
the stimulant applications ; and the vapor of equal parts of 
water and Vinegar with Solution of Opium, is an excellent 
emollient and soothing remedy. 

Counter-irritation is of much importance in this disease, 
and should be freely [employed. I prefer the blister, about 
the size of a dollar, repeated in a new place, before and behind 
the ears, on the temple, and on the back of the neck, say 
every six hours ; marked amendment is frequently observed as 
soon as they begin to draw. If there is marked chemosis 
threatening the integrity of the eye, it is good practice to 
incise it, and thus lessen the pressure ; scarification of the 
conjunctiva sometimes becomes necessary, and is attended 



506 The Eclectic 'Practice of Medicine. 

by alleviation of all the symptoms ; and Mackenzie recom- 
mends that we snip away any loose folds of conjunctiva that 
project from between the eyelids. 

Dr. Hill recommends the Tincture of Myrrh in the puru- 
lent ophthalmia of children, and relates the following case to 
illustrate the success of the practice : "It was allowed to run 
on four or five days before I saw it, and a shocking sight it 
then was; instead of eyes, there appeared protruding out 
beyond the bridge of the nose, two huge, fiery globes — mere 
red fangous-looking masses, nearly as large as hen's eggs. 
The thickening and change in the mucous coat was such that 
nothing like cornea was to be distinguished. It was now all 
one suppurating surface, and the amount of matter discharged 
was surprising. After attempting to allay the violence of the 
symptoms by various other means for two days, I took the 
saturated Tincture of Myrrh, and with it saturated the mon- 
strous-looking eyes. I completely filled them with the fluid, 
and then laid a cloth over them wet and dripping with the 
same. The child cried lustily for a few minutes, but soon 
became easy and fell asleep. The tincture was reapplied 
three times a day for two days, and once on e^ch of the two 
following days, when the cure was complete, the eyeballs hav- 
ing sunk to their natural size, and their surface assumed its 
healthy appearance." ■ Allowing for the exaggerated language 
of the writer, we would still consider this a remarkable case, 
and a marked example of the benefit to be derived from the 
stimulant treatment. I would, however, prefer that first 
named. 



CHROMIC CONJUNCTIVITIS. 

All forms of inflammation of the conjunctiva may become 
chronic either by want of attention or improper treatment ; 
and in many of these cases the patient's life becomes a bur- 
then from the constant suffering and inability to use the eyes. 
Some forms of the disease may continue for years without 
so affecting the structure of the eye as to destroy vision, 
and man}* of the severest cases are amenable to treatment. 

A very common form of chronic sore eyes is that in which 
there is slight injection of the conjunctiva, some secretion of 
muco-pus, epiphora, feeble vision, and intolerance of light to 
such an extent that sometimes the patient can not go in the 



Chronic Conjunctivitis. 507 

open air without the eyes shaded, and in some cases can not 
hear the light at all. In other cases we find associated with 
this condition a tendency to the formation of phlyctenula, or 
there may be but a single ulcer on the cornea, which may 
continue with but little alteration for weeks or months. In 
other cases there is a tendency to the formation of small pus- 
tules on the ocular conjunctiva the inflammation being re-lit 
up on slight exposure. 

The most persistent form of the disease is granular con- 
junctivitis, which may last for years, the patient having partial 
use of his eyes, but being unable to follow any business from 
feebleness of vision and irritation attending any exertion of 
the eyes. It rn,ay result from catarrhal or purulent ophthalmia, 
especially if neglected or improperly treated. On examining 
the eyes we find that they have an unnatural fullness, which is 
caused principally by thickening of the mucous membrane of 
the lids. On everting the eyelid, we find the conjunctiva 
irregular on its surface, what are termed granulations, being 
from the size of the head of a pin to that of a hemp seed. 
It presents a fungous and spongy appearance to the sight, and 
gives the same sensation when touched. Frequently there is 
an uniform deep redness of the entire surface, seeming like 
red velvet, or the fungous enlargements being in patches, they 
are reddened while the intervening space is natural in color. 
In other cases, it seems to he mottled with small, yellowish 
points. " Superficial vascularity, thickening and opacity of 
the upper half of the cornea, often exist with granular con- 
junctiva, and have been attributed to the friction exerted on 
it by the rough surface. This does not, however, appear to 
be the case, for vascularity, thickening and opacity of the 
conjunctiva-cornea are met with in cases in which granular 
conjunctivitis does not exist, and may be absent in cases in 
which granular conjunctiva is much developed. The morbid 
condition of the cornea just mentioned is rather the result of 
the extension of the same inflammation which first gave rise 
to the granular conjunctiva, though there can be no doubt 
that it is kept up and aggravated by the friction exerted by 
the granular surface of the palpebral conjunctiva." — (Jones.) 

The general health is variously affected in these different 
forms of chronic conjunctivitis. The first variety is frequently 
kept up by dissipation, imprudence in eating, damp and ill- 
ventilated dwellings, and in my opinion, by want of cleanli- 



508 The Eclectic Practice of Medicine. 

ness, and cutaneous irritation or disease consequent upon it. 
In phlyctenular ophthalmia the general health is much 
depressed, and the various functions are imperfectly per- 
formed. It is said to be scrofulous, but my observation has 
shown me but two instances in quite a number of cases. It 
may, however, be always considered as a disease of debility, 
and indicative of imperfect nutrition. The pustular form of 
the disease is almost invariably associated with some constitu- 
tional cachexia — two cases in my practice were connected 
with gonorrhoea, three with chronic diarrhoea, and one with 
syphilitic rupia. Granular conjunctivitis may occur with 
depression of the system, or with a full habit of body. 

Treatment. — In the first form of the disease we would reg- 
ulate as far as possible the patient's habits, stimulate secretion 
from the skin and kidneys, using the bath thoroughly and 
frequently. The bowels should be kept in a soluble condition, 
and this may be usually accomplished by the administration 
of the Compound Tincture of Corydalis and Iodide of 
Potassium, and the other secretions stimulated at the same time. 
The Compound Pill of Hydrastin, Quinia and Podophyllin 
may be used in preference to the remedies named, if there is 
much debility. If there is any reason to suppose that the dis- 
ease is connected with rheumatism, we would give #, Extract 
of Conium, 3ss; Iodide of Potassium, 3j ; Tincture of Macrotys, 
f 3 j ; Aqua, fSiij; M.; in doses of a teaspoonful four or five 
times a day. Counter-irritation is among our most important 
curative measures, and hence, in many cases, I prefer the fly- 
blister, first before and then behind the ears, so as to make it 
perpetual. As a collyrium, I frequently use, #, Extract of 
Belladonna, gr. xx; Tincture of Gelseminum, 3ij ; Hydrastin, 
gr. v; Aqua, 3iv; M., and drop in the eyes three or four 
times daily. In place of this I have used, #, Glycerin, Vinum 
Opii, aa, f3j ; Chlorate of Potassa, 3ss ; Aqua, 3ij ; M. In other 
cases, stimulants answer a better purpose, and I adopt Dr. 
Hill's method of using the Tincture of Myrrh or Capsicum, 
and though it is very painful it is often effective. 

In chronic 'phlyctenular ophthalmia, it is necessary that the 
general health should be improved, and we bend all our means 
to the accomplishment of this object. In some cases we will 
find a coated tongue and feeble digestion, with torpidity of 
the entire system ; here a thorough emetic will not only be of 
immediate benefit, but will prepare the way for other medi- 



Chronic Conjunctivitis. 509 

cines. The Compound Tincture of Corydalis, with Iodide of 
Ammonium, has seemed to answer better in my hands than 
other alteratives, and I have usually associated with it Quinia, 
Hydrastin, and Iron. In some cases, Cod-liver Oil and Rye 
Whisky has seemed to benefit the patient in every respect, 
improving the appetite and the power of digestion, and in pro- 
portion to this the condition of the eye. The Salt-water bath 
with brisk friction, especially to the spine, is an important 
aid. The patient should have a full and nutritious diet, and 
occasionally a small quantity of malt liquor is serviceable. 
Open-air exercise is sometimes useful, especially in cases where 
but one eye is affected, as it can be covered to prevent irritation. 
Counter-irritation by means of the continuous blister as 
heretofore named is among our most important means. The 
collyrium of Belladonna, and of Glycerin, Opium, and Chlor- 
ate of Potassa, may be used with advantage, or in occasional 
cases we may use a solution of Nitrate of Silver or Sulphate 
of Zinc, from four to six grains to the ounce of water. The 
stimulant plan of treatment usually gives the best results, and 
I prefer to alternate it with a sedative. Thus, the eye may be 
stimulated with the vapor of Bi-snlphide of Carbon, 3j, being 
added to one ounce of boiling water, and placed in an eye- 
glass or close vessel with a funnel leading to the eye to pre- 
vent the escape of the vapor. It may be continued for two or 
three or ten minutes, or until it smarts pretty freely and starts 
the tears, and should be repeated once or twice a day. In the 
intervening time, the Belladonna and Gelseminum lotion, or 
stimulating collyrium should be employed. 

In granular conjunctivitis, I know of but one way to cure 
the disease, and that is to remove the fungous growth with a 
scalpel. What is termed clipping or scarifying the granula- 
tions, is worse than useless in many cases, and advantageous 
in none. A sharp scalpel being held with the edge at right 
angles to the lid, should be moved across it so as to scrape the 
fungous growth off. This should be repeated every day or 
every other day until removed, or should irritation come up 
after several operations, they should be suspended until it is 
arrested. It might be supposed that great irritation would 
result from this rough procedure, but this is not the case, no 
unpleasant sensations following it. Care must be used not to 
injure the puncta lachrymalia, as permanent epiphora might 
be produced by their injury. The usual plan of treatment is 



510 The Eclectic Practice of Medicine. 

cauterization with a crayon of Sulphate of Copper or Mtrate 
of Silver, but both are notoriously unsuccessful. With the 
plan above advised, no collyria or local applications are neces- 
sary, except occasionally a Belladonna lotion. The general 
treatment should be adapted to each individual case, the 
secretions being kept free. 



RHEUMATIC OPHTHALMIA. 

In the preceding affections the conjunctiva was the seat of the 
inflammation ; in this form it is situate in the sclerotic coat. 
Like other forms of rheumatism, it is produced by cold, sud- 
den atmospheric changes, dampness, etc., but it does not seem 
to attack persons of a rheumatic diathesis more than others, 
and a metastasis of the disease from or to the eye is never 
observed. Hence, it must be confessed that there is no other 
reason for the name than that it resembles rheumatism in its 
exciting causes, and in its accompanying pain and exacerbations. 

Symptoms. — Rheumatic ophthalmia makes its appearance 
with a sensation of heat and dryness in the eye, and stinging, 
darting pains passing from the globe of the eye into the orbit, 
and sometimes to the forehead, temples and face. When the 
disease becomes fully developed, this pain is very severe, and 
seems to involve the entire orbit, but is usually the most 
intense about the superciliary ridge. It never ceases entirely, 
but becomes much modified in the morning, and very intense 
in the evening and fore part of the night. Occasionally the 
pain is of a deep, pulsating or throbbing character,. and some- 
times tearing or tensive. Most generally we find constitu- 
tional symptoms developed, the secretions being arrested; the 
skin especially is dry, and there is considerable excitation of 
the pulse during the paroxysms. 

In pure rheumatic ophthalmia we find the lids entirely free 
from disease, and no muco-purulent secretion. The redness 
is confined to the globe of the eye, and is not in the conjunc- 
tiva, as is readily determined by moving it, when it is seen to 
pass over the dilated vessels. The redness is also different, 
and is seen to consist of fasciculi of vessels advancing in radii 
to the edge of the cornea. Most generally the iris is slightly 
discolored, greenish, and its movements are sluggish; the 
pupil is contracted, and but little changed by light. Dimness 



Rheumatic Ophthalmia. 511 

of vision is always present, depending upon a haziness of the 
cornea and pupil; but then there is little if any intolerance 
of light. In many cases the disease assumes a catarrho-rheu- 
matic character, in fact, these are of far more frequent occur- 
rence than pure rheumatic ophthalmia. In this case we have 
the symptoms of rheumatic ophthalmia associated with the 
catarrhal, and of necessity a very painful and severe disease. 
Here, the conjunctiva is involved, and it is difficult to distin- 
guish the local symptoms of inflammation of the sclerotic, 
and we are usually guided by the character of the pain, and 
the evidence of partial iritis. 

Prognosis. — This form of ophthalmia yields readily to treat- 
ment if taken in time, but if allowed to progress, or badly 
treated, the pupil may close, or the anterior crystaline capsule 
be left opaque. 

Treatment. — If there is derangement of the stomach and a 
coated tongue, I should employ an emetic of the Compound 
Powder of Lobelia and Capsicum, followed by an infusion of 
equal parts of Asclepias and Eupatorium to continue diapho- 
resis. In other cases we might use the warm bath or the 
vapor bath, and give equal parts of diaphoretic Powder and 
Asclepin. Having once obtained free secretion from the skin, 
we should maintain it by the use of small quantities of some 
diaphoretic, as the Diaphoretic Powder, or, #, Essl. Tincture 
of Asclepias, 3 j ; Tincture of Macrotys, 3ss; Carbonate of 
Ammonia, 3j ; Simple Syrup, 3jss; M., and give in teaspoon- 
ful doses every two or three hours. The bowels should be 
kept moderately open, and nothing will be found better for 
this purpose than the Podophyllin Pill, with Extract of Hyos- 
cyamus. A very good combination in these cases when secre- 
tion has been once established, is, £, Extract of Conium, 3ss; 
Iodide of Potassium, 3j ; Tincture of Macrotys, f 3j ; Water, 
giij ; M., and give in teaspoonful doses every four hours. To 
meet the evening exacerbation, we usually employ the warm 
pediluvium, and give the Diaphoretic Powder in such doses as 
to produce perspiration. In some cases full doses of Quinia 
will answer a good purpose. 

Counter-irritation before and behind the ear, and to the 
nape of the neck, is sometimes beneficial, but not to as great 
an extent as in the preceding cases ; it will be used with more 
benefit in the decline of the disease. Eye-waters are useless, 
and the stimulant ones absolutely injurious in this form of the 



512 The Eclectic Practice of Medicine. 

disease. The eye may be washed in tepid or warm water, 
and a dry compress applied lightly, or in some cases fomenta- 
tions of warm water, a soft sponge being used for the pur- 
pose, will be of advantage. To relieve the circum-orbital 
pain, nothing will be more efficient than Extract of Bella- 
donna rubbed up with Tincture of Opium, and applied around 
the eye. It is very necessary that the pupil should be kept 
well under the influence of Belladonna, to prevent structural 
change. Nothing so controls the inflammatory action in this 
disease as the remedy just named; if used with the Lauda- 
num, that will usually be sufficient, if not, the lids may be 
painted with the softened extract. 

In cases of catarrho-rheumatic ophthalmia, we would use the 
general treatment recommended for this disease, counter-irri- 
tation and the local application of Laudanum and Belladonna 
to relieve the pain. All irritant colly ria must be discarded, 
and instead we would employ Belladonna with Gelseminum, 
or Aconite and warn fomentations. ' 



IRITIS. 

Iritis has been divided into several varieties by authors, but 
without any good reason that I could ever perceive. Wc 
might distinguish the syphilitic with advantage, and that 
occurring in scrofulous ophthalmia, but the others may be 
grouped under the simple head of iritis. We have already 
seen that partial iritis was developed in that form termed 
rheumatic, and as the idiopathic iritis bears a very close rela- 
tion to^it, it is generally termed rheumatic. The causes of the 
disease are the same as those giving rise to rheumatic ophthal- 
mia, though it sometimes comes on very insidiously, and with- 
out apparent cause. 

Symptoms. — Dimness of sight and fatigue in using the eye 
is generally the first symptom, and may continue for several 
days before the disease is fully developed. Soon the globe 
becomes sore when pressed upon or when moved, and injec- 
tion of the circum-corneal vessels is noticed. The pain now 
becomes severe, with a feeling of extreme distension of the 
eyeball, and dull pain extending to the orbit and forehead. 
There is much intolerance of light, with increased secretion 
of tears when the eye is exposed. There is usually consider- 
able fever, with coated tongue, constipated bowels, dry skin 



Iritis. 513 

and hard pulse ; it is remittent in character, coming on in the 
evening, with an increase of pain, as in rheumatic ophthalmia. 
Dimness of vision and haziness become very prominent when 
the disease is fully developed. 

If we examine the eye, we will notice a redness situate 
beneath the conjunctiva, and formed of vessels passing in 
radii toward the cornea; usually it' is not deep, but in some 
cases the color is increased by more or less involvement of 
the conjunctiva. The pupil is contracted, and the motions of 
the iris impaired, and its color changed : " first, in the lesser 
circle, which becomes of a dark hue, and afterwards in the 
greater, which grows green, if it had been grayish or blue; 
and reddish if it had become dark-colored. This change of 
color is a never-failing index of the substance of the iris 
being inflamed, and is apt to continue after all the other symp- 
toms of iritis have been subdued." When the disease is severe, 
the pupil loses its circular form, and becomes oval or irregu- 
larly dentated. 

Syphilitic iritis can rarely be distinguished from that just 
described ; the fact of a syphilitic taint existing is the reason 
for the division, and in these cases iritis is almost invariably 
dependent upon the syphilitic poison. Some writers base a 
distinction on the scattered or furuncular appearance of the 
redness for some time, and upon the rusty color of the iris 
near its pupillary margin. The detection of syphilitic disease 
makes the diagnosis certain. Iritis may come up during a 
protracted attack of gonorrhoea, and hence has been described 
as gonorrhceal iritis. It is not produced by inoculation as in 
gonorrhceal ophthalmia, but by constitutional infection, as in 
the case of gonorrhceal rheumatism and synovitis ; it has no 
distinctive features by which it may be determined from other 
forms. 

" Chronic primary scrofulous iritis is characterized by the 
age of the patients, who are generally children under puberty; 
its slowness compared with the progress of the other species ; 
the disease being generally attended with but slight pain, the 
inflammation in a great measure confined to the serous cover- 
ing of the iris, and productive of very little lymphatic effusion. 
In such cases, zonular effusion of the sclerotica, greenness and 
darkness of the iris, and fixedness of the pupil may often be 
observed for many weeks together, without any further mor- 
bid change, so slow is the progress of the disease. There is 
33 



514 The Eclectic Practice of Medicine. 

also, in many cases, little or no pain or fever, and the patient 
often sleeps well. At length the pupil is observed to be tagged 
to the capsule, the capsule becomes partially opaque from 
effused lymph, while, the disease spreading to the retina, 
vision is more or less seriously impaired. Allowed to proceed 
in its course, the disease is now attended with more pain in 
and around the eye, and sometimes with considerable intoler- 
ance of light. The iris bulges forward toward the cornea, 
the pupil is obliterated, and the cornea and anterior half of 
the eye become convex; myopia, hardness of the eye and 
amaurosis, follow more or less promptly. In some cases the 
eyeball becomes baggy and atrophied. In other cases inflam- 
mation and thinning of the sclerotic supervene. 

Prognosis. — The prognosis in iritis is usually favorable if 
proper treatment is adopted, but if neglected or improperly 
managed, it frequently results in opacity of the capsule, oblit- 
eration of the lens, or involving the retina produces amaurosis, 
or the cornea, producing opacity. 

Treatment. — At the commencement we would freely open 
the patient's bowels with a stimulant purgative, as #, Podo- 
phyllin, gr. ss ; Jalap, Ginger, aa, gr. x; Bi-tartrate of Potassa, 
3ss; M., and repeat it every four or six hours until the 
desired effect is produced. Associated with this, to relieve 
the febrile action and favor diaphoresis, we would give, #, Essl. 
Tincture of Asclepias, 3 j ; Tincture of Macrotys, 3ss; Tinc- 
ture of Aconite, gtt. xx; Water, 3ijss ; M., and give in 
teaspoonful doses every one or two hours until the skin 
becomes moist, and afterwards less frequently to continue the 
effect. Acetate or Citrate of Potassa may be added to the 
patient's drink, so that he will take from one to two drachms 
in the twenty-four hours. Associated with these means we 
would use the warm bath or vapor bath, and every evening 
the hot foot bath. In many cases we find that the patient is 
areatly benefited by the use of Quinia and Hydrastin, to the 
extent of from four to six grains of each daily. Turpentine 
in doses of from gtt. xx to gtt. xl, every four hours, may be 
employed in addition, especially when the disease is at its 
height. For the relief of the pain at night, and to give rest, 
Opium should be used in doses sufficient for the purpose, usu- 
ally two or three grains, or Sulphate of Morphia half a grain. 
The combination of Conium, Macrotys, and Iodide of Potas- 
sium will be found valuable in protracted cases. 



Iritis. 515 

If the inflammation is acute, I usually employ small cups 
applied to the temple, and before and behind the ear, with 
scarification if it is thought necessary, and if this is not 
deemed sufficient, a small blister to the back of the neck or 
behind the ear. To relieve the severe circum-orbital pain, 
nothing will be found more efficient than Extract of Bella- 
donna, rubbed up with. Tincture of Opium. Vaporizing the eye 
and side of the head with hot water, or the employment of 
warm fomentations, will sometimes give temporary relief, but 
must not be substituted for more important remedies. One 
of the principal objects of the treatment, and that upon which 
success mostly depends, is, keeping the pupil constantly dila- 
ted. This may be effected by painting the eyelids and brow 
with Extract of Belladonna, rubbed up with a small quantity 
of water. As this is frequently objectionable to the patient 
from its disagreeable odor, and unpleasant sticky sensation, 
it may be replaced with a solution of from three to five 
grains of the Sulphate of Atropia to the ounce of distilled 
water. Of this a drop may be put in the eye once or twice 
in twenty four hours, or oftener than this if required to effect 
the object. 

In syphilitic iritis I employ the Podophyllin, associated 
with tonics and Iodide of Potassium or Iodide of Ammonium. 
We may use the remedies in the following form : #, Podo- 
phyllin, gr. x ; Hydrastin, Quinia, aa, 3j ; Extract of Hyos- 
cyamus, q. s ; M., and make sixty pills, of which one may be 
given every two hours daily, until it operates two or three 
times on the bowels. This will act kindly, and is not debili- 
tating, and is the most efficient alterative I have used in these 
cases. The Iodide of Potassium may be given in from two to 
five grain doses every three or four hours. The local treat- 
ment will not differ from the preceding case. 

In chronic scrofulous iritis we find it good practice to com- 
mence the treatment with a thorough emetic, and repeat it as 
often as the tongue becomes loaded and the appetite impaired. 
The tonic and alterative pill above named may be used; or 
we may give the Compound Tincture of Corydalis and the 
tonics separate. Iron in some form should be used; I fre- 
quently prescribe the Carbonate, or the Citrate. Cod-liver 
Oil is frequently beneficial, especially in cases where the gen- 
eral health is much reduced. The daily use of the Salt-water 
bath, or in some cases using the same warm, or the wet sheet 



516 The Eclectic Practice of -Medicine. 

pack, following- in some instances with Hie douche, and in all 
with brisk friction, is an important addition to the treatment. 
The local measures will not be changed, though in this case 
permanent counter-irritation is advisable. 



PHLEGMONOUS OPHTHALMIA. 

Inflammation of the entire eye is not of frequent occurrence, 
but occasionally a case will be met with. It results most fre- 
quently from injuries, and sometimes follows operations on 
the eye, especially couching for cataract, and for artificial 
pupil. It also occurs during the progress of the eruptive 
fevers — small-pox, measles, and scarlatina, and may result 
from cold or other causes of inflammation. 

Symptoms. — The suffering in this disease is very severe, the 
pain being hot and burning, and extending through the entire 
eye, and to the structures contained within the orbit, and 
increased by movement of the eye or even the body. In 
addition to this, there is a deep seated throbbing pain in the 
eye-ball as if it would burst, and darting pains extending to 
the temples, forehead and occiput. There is generally great 
intolerance of light, and abundant secretion of tears. The 
constitutional symptoms are generally marked, and occasion- 
ally there is delirium. 

On examination we will find the eyelids swollen, and the 
eye prominent, -the edge is red, and the chemosis marked; and 
we will observe that there is marked tumefaction of the cellu- 
lar tissue. The cornea, frequently, is more or less opaque, and 
there is sometimes ulceration. "In this stage the inflamma- 
tion may be arrested, in which case, with diminution of the 
pain, the swelling of the eyelids, the prominence of the eye- 
ball, and the chemosis subside. In proportion as the redness 
of the white of the eye is dissipated, any ulceration of the 
cornea heals, the iris recovers something of its natural appear- 
ance, but the sight remains more or less impaired, if not 
abolished. If this favorable turn is not brought about, but 
on the contrary the disease advances, all the symptoms become 
aggravated and suppuration takes place, being ushered in by 
a feeling of weight and cold in the eye, and general rigors. 
In consequence of accumulation of matter in its interior, the 
eye-ball becomes much distended and enlarged, so that it pro- 



Phlegmonous Ophthalmia. 517 

trncles still more from the orbit. The cornea is infiltrated 
with matter, and projects from the bottom of the fossa formed 
by the chemosed conjunctiva. With the supervention of 
suppuration, the suffering not only does not abate, but actually 
increases, in consequence of the strong outer tunics of the 
eyeball not readily yielding to the distension from the accumu- 
lated matter. At last, however, the eyeball bursts by the 
cornea or sclerotica giving way, and the abscess, together 
with blood and the humors of the eye, are evacuated. The 
pain, which before this was of the severest character, is now 
at once greatly relieved, and afterwards gradually subsides." — 
(Jones.) 

Prognosis. — This is the most dangerous form of ophthalmia, 
and if not promptly relieved in the early part of its course, 
will almost certainly result in loss of vision, if not in complete 
loss of the eye. 

Treatment. — Active but not debilitatins: measures should 
be employed with the first evidences of the disease. We 
would give a brisk purgative, as, #, Podophyllin, gr. ss ; 
Compound Powder of Jalap and Senna, 3j ; Bi-tartrate of 
Potassa, 3ss; and repeat it in six hours if necessary. The 
spirit vapor bath may be used with advantage, giving the 
Componnd Tincture of Serpentaria, and Essl. Tincture of 
Asclepias in doses of a teaspoonful every hour until free 
diaphoresis is induced. As soon as the patient becomes faint 
from the use of the bath, place him in bed, apply warmth to 
the extremities to continue the action, and add a sufficient 
amount of the special sedatives to control the pulse. Cups 
applied to the temples and to the nape of the neck, should 
not be omitted, and these should be followed by cold applica- 
tions, and the use of equal parts of Tincture of Aconite, 
Belladonna and Opium around the orbit. 

The object of the above treatment is to arrest the inflam- 
mation before suppuration commences, and sometimes we will 
succeed. If not, warm fomentations may be substituted for 
the cold water dressing, the bowels kept open by a gentle 
purgative, and a mild diaphoretic and sedative combined, 
with a sufficient quantity of Opium to control pain. If there 
seems to be much general depression, Quinia and Hydrastin 
may be employed, with as much stimulus as may be neces- 
sary. If the eye-ball becomes very much swollen and painful 
from effusion and formation of pus, it w T ill be necessary to 



518 The Eclectic Practice of Medicine. 

puncture the cornea or sclerotica to relieve the suffering, pre- 
vent entire destruction of the globe of the eye, or sometimes 
dangerous disease of the brain, or sympathetic irritation of 
the other eye. These punctures permit the escape of the 
aqueous humor and lessen the distension, and at last give exit 
to the pus. In some cases the inflammation of the cellular 
tissue of the orbit results in suppuration, and in consequence 
the eye is thrown very much forward and the pain is severe. 
If it continues it may endanger the integrity of the brain, and 
terminate fatally. In this case it is necessary to open the ocu- 
lar capsule, which is done by dividing the conjunctiva at the 
internal angle of the eye, passing the lancet close to the 
globe, and- rather toward the lower eyelid, until it reaches 
the accumulation. "This being done, there is an immediate 
gush of serous fluid mixed with pus; the globe of the eye 
falls back, and the cornea becomes flaccid, showing that the 
cause of the excessive hardness and projection of the eye 
existed behind it, and not in the organ itself. In such cases 
the opening of the capsule ought to be had recourse to 
early, and not delayed until the eye is disorganized or the 
patient sinking into a state of coma. The operation is sim- 
ple, and is likely to save both the eye and the life of the 
patient." — (Mackenzie.) 

OPACITY OF THE COKKEA. 

Opacities of the cornea are distinguished by different names 
according to their density and the character and situation of 
the lesion. Nebula is the slightest degree, and is most gen- 
erally situate in the superficial layers, though occasionally 
deep seated; sometimes it is general, and is the result of 
pressure, or serous effusion into the substance of the cornea. 
Allbugo is that form of opacity in which the spot has a pearl y 
appearance, and generally results from effusion of plastic 
lymph, in the anterior layers of the cornea. It usually results 
from phlyctenula which have receded without bursting. Leu- 
coma is an opaque cicatrice closing an ulceration; it has 
usually a contracted and circumscribed appearance, and is 
depressed in its centre. 

Treatment. — "All the three kinds of speck — nebula, albugo 
and leucoma, have a natural tendency to disperse as soon as 
the disease giving rise to them subsides or is removed, and 



Amaurosis. 519 

whether they depend on primary inflammation, spreading to 
the cornea, or secondary inflammation of that part arising 
from the irritation of inverted eyelashes or granular conjunc- 
tiva. We must, then, in every case, endeavor to remove the 
ophthalmia or the mechanical irritation on which the opacity 
depends, assured that if we succeed in this, nature, by the 
process of absorption, will accomplish the whole amount of 
recovery which is possible. In children and young persons 
many very dense and extensive opacities are removed in the 
natural process of growth, which would be quite immovable 
in adult life." — (Mackenzie.) 

Patience and perseverance are the great elements of success 
in these cases, and abundant time, from three months to as 
many years, is necessary to the accomplishment of the pur- 
pose. The inflammation should be entirely removed in the 
manner heretofore named, and if the person is scrofulous this 
should be counteracted as much as possible and the general 
health improved. Frequently this is all that is necessary, the 
opacity disappearing as the inflammation is removed. If after 
this we deem it necessary, we prescribe a mildly stimulant 
collyrium, as, Wine of Opium, pure or diluted, G-elseminum 
as heretofore recommended, Sulphate of Zinc or Nitrate of 
Silver, from two to eight grains to the ounce of water, and 
Glycerin, are some of the means that may be made use of 
The Bi-sulphide of Carbon may be used as heretofore 
directed, as a stimulant to the eye, and will answer a good 
purpose. In other cases, all that is necessary is to give nature 
sufficient time to remove the deposit; and to prevent injuri- 
ous meddling with the eyes, we will in these cases prescribe 
some mild and grateful application simply to occupy the atten- 
tion of the patient and prevent discouragement. 



AMAUROSIS. 

Under the head of amaurosis formerly were grouped all 
those affections in which the vision was impaired, without 
outward evidence of disease. The opthalmoscope has now, 
however, brought to light various diseased conditions of the 
internal parts of the eye, and somewhat restricted its applica- 
tion. Feeble or imperfect vision or complete loss of the 
eyesight, there being no perceptible cause for it, is amaurosis. 



520 The Eclectic Practice or Medicine. 

Dr. Jones enumerates three conditions giving rise to this affec- 
tion, and upon which it essentially depends: 1st. Congestion 
of the optic nerve and its effects. 2d. Exhaustion of the optic 
nervous apparatus. 3. Pressure on some part of the optic 
nervous apparatus. The causes giving rise to the first are : 
exposure of the eyes to strong heat and light in those who 
w^ork before large fires, etc. ; over-exertion of the sight ; forced 
exertion of the body while stooping the head, especially in 
plethoric or drunken persons ; pregnancy ; sudden suppres- 
sion of discharges, the menstrual, perspiratory, hemorrhoi- 
dal, purulent, etc. ; gastro-intestinal irritation ; irritation of 
the nerves of the fifth pair ; passions of the mind. In the 
second case, it is caused by great losses of blood, excessive 
secretion, protracted suckling, seminal losses, from the depress- 
ing emotions, and from low and exhaustive diseases. In the 
third case, there will usually have been symptoms preceding 
the loss of sight, indicating the character of the affection ; 
though in some cases, as when it results from the presence of 
a clot or other formation within the cranium, the amaurosis 
may have been the first symptom. 

Symptoms. — In many cases there are no symptoms of disease, 
either of the eye or brain, further than a gradual loss of vision, 
it seeming as if a film was slowly forming before the eye. In 
others the loss of sight is sudden, and more or less complete. 
While, in a third class of cases, the loss of vision is gradual, 
and attended with pain in the head, dizziness, vertigo, etc., 
indicating disease of the brain. In some cases of partial 
amaurosis we find that vision is better one day, and worse 
another, or that objects are better seen in one direction than 
another, or when moved before the eyes ; sometimes in a 
bright light, at others in a dull light. Occasionally there will 
be ocular spectra, muscse volitantes, double vision, confusion 
and distortion of objects, etc. If we examine the eyes closely 
we will find the pupil more or less dilated, and but slightly 
susceptible to light, though in some cases it is as sensitive as 
in health. 

Diagnosis. — ¥e diagnose amaurosis from cataract, by the 
fact that the opacity is easily recognized, the movements of 
the pupil are natural, and vision is better in a dull light; from 
inflammatory disease of the internal tunics of the eye, by the 
absence of pain and intolerance of light, and by the immobil- 
ity of the pupil. Amaurosis is distinguished from glaucoma 



Glaucoma. 521 

by the extreme hardness of the eye, the persistent pain, and 
peculiar, greenish-opaque appearance. 

Prognosis. — In the first case the prognosis is far more favor- 
able than in the other two, for if seen early, and the exciting 
causes can be avoided, we mnj hope to give relief. In the 
second and third cases we may relieve some few, but the 
majority are incurable. 

Treatment.— As will be noticed, there is a marked differ- 
ence in the pathology of these cases, and consequently there 
will he great difference in the treatment. When we have 
reason to believe that it results from congestion we would give 
brisk, stimulant purgatives, use cups around the eyes, counter- 
irritation to the spine, and alkaline diuretics. If of some 
duration, we would employ the tonic and alterative plan 
recommended previously, with counter-irritation before and 
behind the ear, and to the nape of the neck. In addition we 
may use the JSTux Vomica and Strychnia with advantage, and 
in some cases Electricity. In the second class of cases, we 
would adopt a tonic and sustaining course of medicine, with 
Cod-liver Oil, the bitter tonics, Iron, Sulphur, and Phospho- 
rus. Here we may occasionally obtain the most marked 
beneficial results from the use of Nux Vomica, Belladonna, 
Ergot, etc., as named under the head of paralysis. Electricity 
may also be employed with some advantage, a gentle current 
being passed from the occiput through the eye, the anterior 
pole being covered with a piece of soft sponge, and and applied 
directly to the eyeball. If the amaurosis has resulted from 
pressure, it may, if from a tumor, be removed by an opera- 
tion; but if within the cranium we will have to treat the case 
according to the indications as they may be developed. 



GLAUCOMA. 

This name is applied to a peculiar disease of the eye, in 
which it presents a greenish appearance, deep behind the 
pupil. It usually comes on slowly, requiring years before it 
involves the structure of the eye so as *o produce complete 
loss of vision ; in other cases these changes take place in a 
few months. The causes of glaucoma are obscure, as is also 
its pathology. Some have contended that it was dependent 
upon a chronic inflammation of the internal structures of the 



522 The Eclectic Practice of Medicine. 

eye, while later observers, especially Mr. Hancock, believe it 
to be due to obstruction of the circulation by spasmodic or 
tonic contraction of the ciliary muscle, or as it is usually 
termed, ciliary ligament. It most usually commences after 
middle age, though occasionally cases are seen between the 
ages of twenty-five and forty. 

Symptoms. — The symptoms are variable and the disease 
seems to have no connection with the general health of the 
patient. In acute cases there is a more or less sudden access- 
ion of deep-seated, tensive pain in the eyeball, which is seen 
to be somewhat injected, and is hard, when pressed upon with 
the fingers. The pupil is usually irregularly dilated, and the 
field has a peculiar muddy appearance, and vision is more or 
less impaired. If not promptly arrested it gradually passes 
into the chronic form, with such structural changes as ulti- 
mately destroy vision. In the chronic form of the disease it 
may have been progressing for months or even years without 
attracting attention, though sometimes amaurosis results in 
the first stages, and before the hardness and greenish opacity 
is much developed. In the second stage of the disease vision 
gradually declines, but without pain or any external marks of 
the disease. If we examine the eye closely, we will find the 
greenish, muddy appearance well marked, aud the eye hard 
to the touch. In the third stage, we have immobillity, and une- 
qual dilatation of the pupil, a varicose condition of the exter- 
nal vessels, and marked hardness of the eye on pressure. 
There is also, frequently muscre volitantes, fiery and prismatic 
spectra and ocular delusions. " In this stage the choroid is 
inflamed; effusion takes place upon its internal surface; the 
retina is compressed; the vitreous tissue is disorganized, and 
superabundant watery secretion comes to occupy its place. 
For a time the eye may continue sensible to objects placed to 
one side or the other of the patient, while in every other 
direction nothing is distinguished." In a later stage the crys- 
taline lens becomes opaque, and passing forward through the 
pupil touches the cornea, which being irritated ulcerates and 
gives way, permitting the escape of more or less of the con- 
tents of the eye, which becomes shrunk and atrophied. 

Prognosis. — The prognosis in glaucoma is very unfavora- 
ble; except in the first and second stages there is no chance 
of arresting the disease. Even when it appears in but one 



Cataract. 523 

eye, we have reason to suppose that the other will also be 
involved. 

Treatment. — An active alterative course of treatment at 
the commencement of the disease may prove successful; but 
it should be combined with tonics to prevent debility. The 
Podophyllin Pill, with Compound Syrup of Stillingia and 
Bromide of Potassa, and a suitable quantity of Quinia and 
Hydrastin, will answer a good purpose. The skin should be 
stimulated to action by the use of the warm or cold bath, as 
seems best adapted to the case. In the acute affection these 
means should be thoroughly used. Eest to the eyes is of 
absolute importance, and to remove excitation we would use 
the irritating plaster, or other counter-irritant. The fever 
may be controlled by the internal use of Belladonna or Acon- 
ite, or in some cases Opium. 

Three operations have been- performed for the relief of 
glaucoma, two of which may be employed in the early stage 
of the disease. They are, first, iridectomy, or the removal of a 
portion of the iris, either by an incision through the cornea 
or sclerotica; and secondly, the division of the ciliary liga- 
ment or muscle. The third, or extraction of the lens, has not 
been attended with success. 






CATARACT. 

Opacity of the crystaline lens is called cataract, of which 
two varieties are now described, the hard and soft. The causes 
of cataract are imperfectly known, but they are such as give 
rise to mal-nutrition of the lens. ~Eo pain attends its forma- 
tion, and the patient is sensible of the disease only by the 
continually increasing loss of vision. For some time it will 
be noticed that the patient can see better in a subdued than in 
a bright light, and at last only in a darkened room, or in the 
evening. In some cases vision is almost entirely lost, the per- 
son only being able to distinguish day from night. We fre- 
quently find but one eye affected, and the other may remain 
sound through life, though it is usually affected sooner or 
later. Usually there is but little difficulty in its diagnosis, the 
pearly appearance of the lens, the perfect mobility of the 
pupil, some degree of vision in a dull light, and the history 
of the case is sufficient. The only disease with which it could 



524 The Eclectic Practice of Medicine. 

readily be mistaken is glaucoma, and that is a very rare affec- 
tion. Its treatment is entirely surgical, no remedies having 
any influence over its formation or progress. 



DISEASES OF THE LACHRYMAL APPARATUS. 

The lachrymal gland is so protected within the orbit that it 
is rarely the seat of disease. Inflammation sometimes occurs, 
and is marked by pain in the region of the gland and dryness 
of the eye from arrest of secretion. When the inflammation 
subsides there is usually too free secretion and epiphora, but 
this soon subsides. It should be treated as any other inflam- 
mation. 

Inflammation of the lachrymal sac is of frequent occurrence, 
and requires care in its management. It makes its appear- 
ance usually as a diffused, erysipelatous-like redness and swell- 
ing of the parts near the internal canthus, with deep-seated 
pain, and more or less irritation of the conjunctiva, increased 
lachrymation, and passage of the tears over the eyelid. This 
inflammation continuing for some days, the parts become 
much swollen and very painful, and at last pus having 
formed, it discharges through the integument. In some 
cases the pus finds its way through the lachrymal canals by 
pressure, and the inflammation becomes chronic, but without 
the formation of a fistula. Usually there is lesion of the 
nasal duct, which remains permanent unless an operation i3 
undertaken for its removal, though sometimes the closure of 
the nasal duct is the primary affection, the inflammation of 
the lachrymal sac being caused by it. 

At the commencement of the disease, the local application 
of equal parts of Tincture of Aconite and Belladonna to the 
part, or painting it with Tincture of Muriate of Iron, or Com- 
pound Tincture of Iodine, will remove inflammation and pre- 
vent suppuration. A brisk purgative, followed by the hot 
foot bath and an active diaphoretic, occasionally proves useful. 
If pus forms, an incision should be early made for its remo- 
val, thus preventing change of the lachrymal sac, and espe- 
cially distension, and permanent closure of the nasal duct. 
An injection of ten or twenty grains of Sesqui-carbonate of 
Potassa to the ounce of water, will now assist very much in 
effecting a speedy cure. As soon as the inflammation sub- 
sides, if the nasal duct seems closed, a style should be inserted. 



Diseases of the Lachrymal Apparatus. 525 

Closure of the nasal duct, producing fistula lachrymalis, fre- 
quently results from the above inflammation, though it may 
be produced by injuries of the bones or soft parts, or an exten- 
tion of inflammation to its mucous lining from the nose, or 
from the conjunctiva. In a majority of cases there is a 
fistulous opening over the lachrymal sac, or a continuous 
suppuration and discharge of pus at the internal canthus, 
through the puncta, with more or less frequent attacks of 
acute inflammation of the sac, and discharge through the 
integument. In some of these cases a fungous-looking mass, 
of considerable size, is found upon the site of the lachrymal 
sac, which is constantly discharging pus mixed with tears. 
This, and the constant flowing of the tears over the eyelid, 
is very unpleasant, and occasionally it keeps up continuous 
irritation of the eye, and causes imperfect vision. The dis- 
ease is only cured by an operation, which consists in opening 
the lachrymal sac and introducing a silver style made for the 
purpose. The usual means to relieve irritation are then made 
use of, and the style retained until there is evidence of the 
free passage of the tears and restoration of the mucous mem- 
brane lining the duct, when it is removed and the external 
opening allowed to heal. 

The puntta or canaliculi may be obstructed from inflamma- 
tory action, and occasionally from other causes. In these 
cases there is also the overflow of tears and irritation of the 
lid. If it is produced by inflammation, the means heretofore 
named may be used to arrest it. If from other causes an 
Anel's probe may be passed into the puncta and through the 
canaliculi into the sac, with the result of removing the 
obstruction. 

The caruncula lachrymalis is sometimes the seat of inflam- 
mation very similar to that in ophthalmia tarsi, and by 
displacement of the puncta will produce watering of the eye. 
It sometimes gives rise to considerable uneasiness and pain. 
It may be treated in the same manner as the other inflamma- 
tions named, but when persistent is best removed by the use 
of the mild Zinc Ointment, or Ophthalmic Ointment, Occa- 
sionally they are the subject of chronic enlargement, forming 
a red, soft, tuberculated tumor, of considerable size, which 
bleeds readily on pressure. It may be occasionally removed 
by the application of a saturated solution of Tannic Acid, or 



526 The Eclectic Practice of Medicine. 

the solid Nitrate of Silver, but in many cases will have to be 
excised, one half or more being cut away, the remainder dis- 
appears. 

Pterygium. — This is strictly a disease of the conjunctiva, and 
consists of a thickening of a circumscribed portion of it 
extending between the internal canthus and the cornea, 
though occasionally it is found on the temporal side. It is 
divided into two kinds, the membranous and fleshy, both kinds 
being triangular, with their apex towards the cornea. It 
commences from without, and grows inward, occasioning but 
little disturbance until it reaches the cornea. If it commences 
to involve the conjunctivaB-cornea, it gives rise to irritation, 
and may be attended with serious consequences. It may be 
arrested by cauterizing with Nitrate of Silver, or other eschar- 
otics, but the easiest plan is to dissect off the half next the 
cornea when the remainder will generally disappear without 
trouble. 



OTITIS. 

Quite a number of different affections have been grouped 
together under the head of otitis, and as they are all inflam- 
matory, present similar symptoms, and require nearly the 
same treatment, it will hardly be worth while to endeavor to 
make the distinction. Inflammation of the external auditory 
meatus and cavity of the tympanum are usually produced by 
sudden changes of temperature, though it may be caused by 
the introduction of irritants or even from accumulation of 
cerumen. 

Symptoms. — Inflammation of the external auditory meatus 
commences with a feeling of stiffness, fullness and uneasiness 
about the meatus, which is increased when the ear is pressed 
upon. In a short time the pain becomes very severe, is ten- 
sive, darting, lancinating, and seems to affect the entire side 
of the head to some extent. Frequently there are marked 
chilly sensations with the accession of the severe pain, and 
these are followed by febrile reaction. On examination we 
will-find the lining membrane of the meatus tumid and red, 
sometimes swollen so as almost entirely to close the opening. 
The pain continuing for from two to six days, secretion takes 
place,or pus is formed and discharged, sometimes in consider- 
able quantity. At first it is usually thick, but at last is thin, 



Otitis. 527 

and in some cases is secreted in very large quantity. The 
discharge continuing for a short time, the symptoms of 
inflammation entirely disappear, and the part is restored to 
its normal condition. 

Acute inflammation of the cavity of the tympanum, is a 
far more serious affection, and may result in permanent 
impairment of the hearing, or even in death by extension to 
the brain. In children this is usually very severe at night, 
with comparative ease during the day, though the child is 
restless and irritable. There is usually considerable fever at 
night, and even during the day; the skin is dry and the pulse 
hard. 

" In the adult this affection is usually of a much more form- 
idable nature, and it sometimes has a rheumatic or gouty 
character. The first symptom is a sense of uneasiness in the 
ear, which becomes painful during motion, pressure on the 
organ, the act of deglutition, or the use of the pocket hand- 
kerchief. This uneasiness soon amounts to continuous pain, 
which in severe cases, rapidly increases until it becomes so 
intense as to be scarcely endurable, and extends over the 
mastoid process, the whole of the affected side of the head, 
down the neck, and into the fauces. The power of hearing 
rapidly diminishes, and a variety of the most horrible sounds 
are experienced, sometimes described as like the hissing and 
puffing of a steam engine, varied by others like a series of 
explosions in the ear, or the ringing of bells. A symptom of 
this affection, which adds greatly to the suffering of the 
patient, is the impairment of the functions of the brain, some- 
times amounting only to a confusion of ideas, frequently 
accompanied by extreme fever and depression of the nervous 
system, causing the worst forebodings as to the result of the 
attack ; in other cases, delirium supervenes ; and in the most 
formidable cases death takes place from the inflammation 
extending to the membranes of the brain. " — (Toynbee.) In 
some rare cases the inflammation attacks the mastoid cells, 
producing severe and circumscribed pain in that locality, and 
occasionally terminating in suppuration, and sometimes serious 
lesion of the brain if the pus is not permitted to escape. 

Diagnosis. — Inflammation of the ear presents such marked 
symptoms that it is not easily mistaken. The severity of the 
pain, and its location, and attendant constitutional disturb^ 
ance, are sufficiently characteristic. If the external meatus is 



528 The Eclectic Practice of Medicine. 

the seat of the disease, it will be found red and swollen, as is 
the case if the membrana tympani is affected. If confined to 
the cavity of the tympanum, all the symptoms are more severe 
and there is an absence of external signs of inflammation. 
When the inflammation extends to the mastoid cells, the 
constitutional disturbance is very marked, and when pus 
forms, the deep throbbing and marked disturbance of the 
brain shows the character of the lesion. 

Prognosis. — Though quite painful, inflammation of the 
external meatus is not dangerous, nor attended with worse 
results than otorrhoea in occasional cases. If the tympanum 
is affected there is some danger of affection of the brain, and 
considerable of impairment of the hearing. Inflammation of 
the mastoid cells, if it progresses to suppuration, is always 
dangerous. 

Treatment. — Though the inflammation is confined to such 
a small portion of the body, it demands active treatment. I 
should in this case use the spirit vapor bath wheu first called, 
giving Tincture of Serpentaria and Essl. Tincture of Asclcpias, 
equal parts, in doses of a teaspoon ful every hour or two hours 
until free perspiration was induced and the pain mitigated. 
After the bath the patient should be covered warmly in bed, 
and kept there until the inflammation has subsided. An 
emetic may be used to produce the same result, but it must be 
thorough, and followed by a diaphoretic. A brisk, stimulant 
purgative may occasionally be used with advantage. 

Locally we would direct the use of cups over the mastoid 
process and in front of the ear, or sometimes the application 
of leeches in the case of an adult. This may be followed by 
the use of the vapor of water, and hot fomentations of Stra- 
monium. Occasionally much relief is obtained from the use 
of a lotion of equal parts of Tincture of Aconite and Bella- 
donna, applied around the ear. In some cases, the fever 
being very intense, we may employ the vapor of Tincture of 
Opium, Stramonium, Lobelia, Tobacco, etc., directly to the 
external meatus and membrana tympani, by means of a gutta- 
percha tube. Chloroform and ^Ether may be used in the 
same way, as may also Carbonic Acid Gas. If the disease 
seems to extend to the mastoid portion of the bone, I should 
apply a blister immediately over it, and follow it with the 
irritating plaster. In some cases, suppuration having un- 
doubtedly taken place, and dangerous symptoms occurring 



Otorrhoea. 529 

it becomes necessary to open into the mastoid cells through 
the bone, in order to permit the escape of pus. 



OTOBRHCEA. 

Purulent discharges from the ear may be occasioned by 
chronic inflammation of the external meatus, or disease of the 
bony canal, or it may proceed from chronic inflammation of 
the tympanum, or disease of adjacent parts, the membrana 
tympani having been ruptured or destroyed, so as to permit 
its escape. In either case there is more or less deafness, 
uneasiness in the ear, and an offensive discharge. The most 
frequent causes of otorrhoea are inflammation attending the 
eruptive fevers, injuries, the direct action of cold, and chronic 
inflammation resulting from an acute attack. Some families 
seem to have a predisposition to this affection, the majority 
of their children having such discharge. In such cases it is 
almost always associated with scrofula and feeble vitality. 

Otorrhoea from disease of the external auditory meatus is the 
most frequent form of the affection, and might properly be 
called chronic catarrh. It is of frequent occurrence after scar- 
let fever and measles, and is often seen in infancy or up to 
the age of two or three years, becoming more rare as we 
advance to adult age, except in the cases named. It is true, 
that the disease commencing at the age of two or three years 
may continue through life, but this is not very common when 
the patient has sufficient vitality to reach adult age. Farther 
than the discharge from the ears of an offensive purulent 
matter, and some dullness of hearing, there are no prominent 
symptoms, if we except the almost invariable cachectic 
appearance of the child. On examining the ear, we will find 
the bone in a carious condition. When the hearing is much 
affected, we will find the membrana tympani opaque, and its 
dermoid layer thick and vascular. In some cases, the dis- 
charge is produced by a small polypoid formation in the ear, 
and in others by a hardened cerumen. 

Otorrhoea from disease of the middle ear occurs only when the 
membrana tympani has been destroyed or ruptured, and may 
arise from chronic inflammation of the lining membrane, dis- 
ease of the ossicles, or disease of the bony walls. It is most 
generally the sequence of acute inflammation, which termina- 
34 



530 The Eclectic Practice of Medicine. 

ting in suppuration, the membrana tympani gives way, and 
the inflammation gradually assumes the chronic form. There 
is always deafness, sometimes but slight, but at others marked. 
There may or may not be pain or unpleasant sensations in 
the ear, though usually if there is but a slight opening in the 
membrana tympani it occasionally becomes closed, and dizzi- 
ness, ringing in the ear, etc., result from the pressure of the 
retained secretion. 

The condition of the tympanum varies greatly; in some 
cases there is but slight change of structure, in others, the 
ossicles become diseased, and are cast ofT, the mastoid cells 
and eustachian tube are affected to some extent, and the 
hearing is nearly entirely destroyed. It may occasionally 
terminate fatally by an extension of the inflammation to the 
membranes of the brain. 

Treatment. — In all cases it becomes necessary to pay atten- 
tion to the general health, for as long as the child or adult 
continues cachectic it is almost impossible to arrest the dis- 
charge. We would put the patient on a tonic, bracing course 
of medicine, consisting of the bitter tonics and Iron, associ- 
ated with a vegetable alterative, as the Compound Syrup of 
Stillingia, or the Compound Tincture of Corydalis. Especial 
attention should be paid to the skin, using the daily bath and 
following with brisk friction; exercise in the open air is also 
important. 

Prominent among local applications in all forms of this 
affection, except when occasioned by a foreign body lodging 
in the ear, or a polypoid growth, is counter-irritation over 
the mastoid process. It should never be neglected, but pur- 
sued steadily until the cure is complete. The best agent that 
I have ever employed is the Cantharides, which may be 
repeated sufficiently often to keep up a continued influence. 
In common chronic inflammation of the external meatus, 
washing the ear out thoroughly with tepid water, and drop- 
ping three or four drops of, #, Tincture of Muriate of Iron, 
3ij ; Glycerin, 3j ; M. ; into the ear once or twice daily, will 
effect a cure in one or two weeks. A weak solution of 
Nitrate of Silver, Sulphate of Zinc, or Acetate of Lead, from 
four to ten grains to the ounce of water, may be used in some 
cases. #, Chlorate of Potassa, gr. xx; Glycerin, 3ss; "Water, 
f 3 j ; M., also forms a good application. An infusion of 
Hydrastis, Cornus, Geraniin, Sage, etc., are found useful in 



Deafness. 531 

some cases. Occasionally I have employed Oxide of Zinc, 
gr. x, rubbed up with Glycerin, 3ss, addding a small portion 
of Morphia, if necessary, to relieve irritation. 

If the tympanic cavity is the seat of disease, we will pay 
especial attention to the general health, and keep up contin- 
uous counter-irritation near the ear. Cleanliness is of prime 
importance, and hence the ear should be thoroughly washed 
out, once or twice daily. This may be followed by some of 
the lotions above named, being careful that they are brought 
in contact with the diseased surface. 

If the discharge is produced by accumulations of hardened 
cerumen acting as a foreign body, this should be softened 
and removed with a scoop. If from a polypus, and it is not 
red and vascular, it may frequently be removed by the appli- 
cation of a saturated solution of Tannin, or the careful appli- 
cation of Chloride of Zinc. The best plan, however, in all 
cases, is to catch it with a strong pair of ring forceps, and 
detach and remove it. 



DEAFNESS. 

Partial loss of hearing depends upon various causes, some 
of which are remediable; total deafness depends upon disease 
of the internal ear, and if of any considerable duration is 
incurable. We wish, therefore, in this place, to inquire into 
the causes of partial deafness, and see how far they are amen- 
able to treatment. We may sum them up, as: 1st, from 
disease of the external meatus; 2d, from disease of the mem- 
brana tympani; 3d, from disease of the tympanum; and, 4th, 
from disease of the eustachian tube; diseases of the internal 
ear are beyond our powers of diagnosis, though we are able 
occasionally to determine with considerable certainty that the 
deafness is dependent upon partial paralysis — we call this ner- 
vous deafness. The ear-speculum should always be used, so 
as to make an accurate diagnosis. 

1. The external meatus suffering from chronic inflammation 
will give rise to hardness of hearing as we have already seen. 
In other cases the lining membrane is thickened and dry, and 
in addition, the ceruminous glands seem to pour out a very 
inspissated secretion, which desiccating sometimes fills up the 
bottom of the meatus. In this case we would use injections 
of tepid water and the scoop, to thoroughly cleanse the ear, and 



532 The Eclectic Practice of Medicine. 

then use the lotion of Tincture of Muriate of Iron and Gly- 
cerin, heretofore mentioned. The lotion, of Chlorate of 
Potassa and Glycerin may also be used in these cases. If 
there is irritation of the structures, much benefit will be 
derived from counter-irritation over the ear. Polypi obstruct- 
ing the meatus should be removed as before mentioned. 

2. A condition of chronic inflammation of the membrana 
tympani, giving rise to a fleshy, vascular appearance when 
examined with the speculum, is sometimes a cause of deaf- 
ness; quite frequently it is associated with catarrhal inflam- 
mation of the meatus, though it may persist afterwards. An 
injection of a decoction of Cornus or Hydrastis, and the local 
application with a camel's hair pencil of the Oxide of Zinc, 
Morphia and Glycerin, heretofore named, is usually sufficient. 
Counter-irritation over the mastoid process is also employed. 
Relaxation of the membrana tympani is not of frequent occur- 
rence, but may occasionally be met with as a cause of deaf- 
ness. It is readily determined by the use of the speculum, the 
membrane being remarkably concave on its external face, and 
is diagnosed from the same appearance resulting from closure 
of the eustachian tube, by its being thrown outward by swal- 
lowing with closed nostrils. It is usually removed readily by 
the use of counter-irritation, the local application of a solu- 
tion of Nitrate of Silver, four grains to the ounce of water, 
and an injection of a decoction of Cornus or Hydrastis. 

Perforation of the membrana tympani is a frequent cause 
of deafness, and is readily detected with the speculum. It 
seems, however, that.the deafness depends in part upon thick- 
ening of the mucous membrane of the tympanic cavity, for 
when this is marked the patient can hardly hear at all, while 
in other cases the deafness is but slight. We should there- 
fore endeavor to remove all irritation by the use of counter- 
irritants and appropriate local applications, and we will then 
have placed the patient in the best condition for the use of 
the artificial membrana tympani; this is formed out of vul- 
canized rubber, and has been very successfully employed. 

3. Various changes in the tympanic cavity, resulting from 
inflammation, may be the cause of deafness, but there is only 
one, so far as we know, that can be reached by remedial meas- 
ures. We have already noticed that a chronic inflammation 
of these structures might continue for years, attended with 
secretion; and examination shows us in some cases, a thick- 



Deafness. 533 

erring of the lining membrane, with increased vascularity. In 
these cases, the persistent use of counter-irritation and the 
local means heretofore named will do much towards a relief 
of the deafness. 

4. Obstruction of the eustachian tube always gives rise to 
partial deafness, though, as the causes are usually temporary, 
the deafness is not of long duration. Dr. Toynbee notices 
three points of obstruction: 1, at its faucial orifice, a thicken- 
ing or relaxation of the mucous membrane; 2, at its tympanic 
orifice, from thickening of the mucous membrane, or a deposit 
of fibrin; 3, in the middle part of the tube, from a collection 
of mucous, a stricture of the osseous or cartilaginous por- 
tions, or membranous bands connecting the walls. If the 
eustachian tube is impervious, we will find the membrana 
tympani sunken in, of a dull, leaden hue, and its surface 
unnaturally glossy, and swallowing with the nose closed or 
forcible expiration will not have any effect on it. 

If the patient has had disease of the tonsils, fauces, or pos- 
terior nares, we may reasonably suppose that the disease has 
been caused by this, and is at the faucial extremity of the 
tube. The inflammation sometimes extends to the mucous 
membrane lining the tube, and its tumefaction causes the dis- 
ease. In other cases the swelling of the mucous membrane at 
the termination of the tube is the cause of it, and in another 
class it results from relaxation. In these cases, appropriate 
measures to relieve inflammatory engorgement in the one 
instance, and to remove the atony and relaxation in the other, 
should be adopted. The orifice of the eustachian tube may 
be reached through the mouth or inferior meatus of the nose, 
and local applications may be made with a probang or syringe. 
In some cases it is proposed to remove obstructions by means 
of a catheter passed into the eustachian tube, but no perma- 
nent benefit results from it. We may, however introduce a 
catheter for the purpose of using an injection into the tube, 
using the same remedies that would be indicated in other 
situations, as, for instance, those recommended in otorrhoea. 

Nervous Deafness. — Toynbee remarks that "As some cases 
of deafness dependent upon the derangement of the nervous 
apparatus connected with the organs of hearing appear to be 
caused by the condition of the brain generally, or of that part 
in intimate relation with the acoustic nerve, it has seemed 
desirable to divide the nervous diseases of the ear into two 



534 The Eclectic Practice of Medicine. 

classes; to the first of which belong those cases where the 
special nervous apparatus of the organ is alone affected; to the 
second, those where the brain conjointly with the ear, seems to 
be injured. The first class may be divided into diseases 
arising from: 1, concussion; 2, the application of cold; 3, 
various poisons, as that of typhus, scarlet, or rheumatic 
fevers, of measles and mumps, of gout, of an accumulation of 
bile in the blood, and of quinia in large doses. And the 
second into diseases arising from: 1, excess of mental excite- 
ment; 2, physical debility. 

In the first class of cases there is- not unfrequently ringing 
and singing in the ears, with other morbid sounds, and some- 
times a feeling of giddiness and unsteadiness extremely 
unpleasant. From its commencement there is frequently a 
continuous increase in the deafness; but in other cases it 
remains the same, and in still others there is gradual improve- 
ment. It is generally conceded that in very many cases there 
is congestion of the nervous apparatus of the internal ear, 
though if it continues for a considerable time it will very 
likely terminate in structural change. The treatment in 
these cases consists in the administration of alteratives, keep- 
ing the bowels open, and the secretion of the kidneys free, by 
the administration of the saline diuretics, and normal action 
of the skin by the daily use of the bath with friction. Per- 
sistent counter-irritation over the mastoid portion of the tem- 
j:>oral tone, with Cantharides or the irritating plaster, is one 
of the most important parts of the treatment. These meas- 
ures, followed up for months, will occasionally produce the 
most marked benefit, the hearing being sometimes completely 
restored; but in other cases no benefit results. 

In the second class of cases we will have more or less evi- 
dence of cerebral disturbance, though frequently the symp- 
toms are imperfectly marked. No treatment can be laid 
down for these cases, as the symptoms are so variable and 
changing. They should be treated on general principles, and 
we will sometimes be agreeably surprised at a favorable ter- 
mination in cases which had seemed hopeless; and not unfre- 
quently we will fail when we seemed to have the best chance 
of success. 



Diseases of the Skin. 



535 



CHAPTER IX 



DISEASES OF THE SKIN". 

There is no class of diseases that is less understood by the 
general practitioner, than affections of the skin, and yet there 
is no reason why this should be so, as they are of frequent 
Occurrence, and being situate where they may be accurately 
examined by sight and touch, they are readily recognized. 
The causes of diseases of the skin are various; some are pro- 
pagated by contagion, others arise from want of cleanliness 
or mechanical irritation of the skin, and a third class depend 
upon disease of the blood, or arrest of secretion. To obtain 
an accurate knowledge of these affections, it is necessary to 
group them together as they correspond in general symptoms 
and appearances, and study them [in classes. The classifica- 
tion of Biett is perhaps the best for the student: 



Order I. 


Exanthemata, 




Mentagra, 




Erythema, 




Porrigo. 




Erysipelas, 


Order V. 


Papula, 




Roseola, 1 ! 




Lichen, 




Rubeola, 




Prurigo. 




Scarlatina, 


Order VI. 


Squama. 




Urticaria. 




Lepra, 


Order II. 


Vesicul^. 




Psoriasis, 




Miliaria, 




Pityriasis, 




Varicella, 




Ichthyosis. 




Eczema, 


Order VII. 


Tubercul^i. 




Herpes, ' 




Elephantiasis, 




Scabies. 




Molluscse, 


Order III. 


Bullae. 




Framboesia. 




Pemphigus, 


Order VIII. 


Macule. 




Rupia. 




Color ationes, 


Order IV. 


PuSTULiE. 




Fuscedo Cutis, 




Variola, 




Ephelides, 




Vaccinia, 




IsTgevi, 




Ecthyma, 




Decolorationes, 




Impetigo, 




Albinismus, 




Acne, 




Vitiligo. 



536 The Eclectic Practice of Medicine. 

Each of these orders have certain grand characteristics by 
which they are recognized, and each division will have these 
markedly defined, forming its most prominent symptoms ; 
those peculiar to the affection being sometimes well marked, 
and at others rather obscure. Cazenave describes the impor- 
tant symptoms of each class, as follows: 

Exanthemata. — This term is applied to patches of a reddish 
color, varying in intensity, size, and form, disappearing under 
pressure of the finger, and terminating in delitescence, reso- 
lution or desquamation. 

Vesiculce. — A vesicle is a slight elevation of the epidermis, 
containing a serous and transparent fluid, which, however, is 
occasionally opaque or sero-purulent. The vesicle may termi- 
nate in absorption of the fluid, slight desquamation, excori- 
ation, or the formation of small thin incrustations. 

Bulla?. — Generally speaking bullae differ from vesiculse merely 
in size; they are small superficial tumors, caused by effusion 
of serum underneath the epidermis. 

Pustulce. — This term should be strictly confined to circum- 
scribed collections of pus on the surface of the inflamed mucus 
layer. The contents of the pustules in drying produce scales, 
and they may be followed by chronic induration, or by red 
inflamed surfaces, or sometimes by slight excoriation. 

Papula?. — These are small elevations, which are solid, resist- 
ing, and never contain any trace of fluid; they may likewise 
give rise to ulceration, but generally terminate in resolution 
and furfuraceous desquamation. 

Squamce. — The term squamae is applied to the scales of 
thickened, dry, whitish, friable and degenerated epidermis, 
which cover minute papular elevations of the skin ; they are 
easily detached, and may be reproduced for an indefinite 
length of time by successive desquamations. 

Tubercular. — These are small hard tumors more or less prom- 
inent, circumscribed in form, and persistent; they may become 
ulcerated at the summit, or suppurate partially. In this 
definition we consider tubercles as elementary lesions, and 
not those which appear after abscesses. 

31aculce. — Are permanent changes in color, in certain points 
of the skin, or of the whole cutaneous envelope, but unat- 
tended with any general derangement of the health. 



Exanthemata. 537 

ORDER L— EXANTHEMATA. 

The general characteristics of this order are well marked at 
first, though in the progress of the disease they may so 
change that they will approximate some of the others. They 
always commence with redness of the skin, which is effaced 
for the moment by pressure, returning as soon as this is 
removed. Some of them, as erysipelas, rubeola and scarlatina, 
are attended with marked constitutional disturbance, and in 
the last two as we have already seen, the cutaneous disease is 
associated with disease of the throat and respiratory apparatus, 
and in all three of the diseases named there is in some cases 
marked lesion of the blood. 

Erythema. 

Erythema is one of the mildest of the exanthemata, and 
usually is not accompanied with febrile action, though in the 
severer cases there is arrest of secretion and some constitu- 
tional disturbance. It may be associated with other diseases, 
and is thus with intermittent and remittent fever, gastric irri- 
tation, and diarrhoea. It may be produced from mechanical 
irritation of the skin, but the most frequent causes are cold 
and arrest of cutaneous secretion, or gastric, intestinal, or 
menstrual derangements. 

Symptoms. — The disease appears in the form of patches of 
variable size, of a light, superficial red color, readily effaced 
by pressure, and most frequently on the face, chest and limbs. 
In some cases they spread so as to cover a considerable por- 
tion of the body, but this is not frequent. One form, termed 
erythema nodosum, is preceded by slight constitutional disturb- 
ance, and comes out in oval, red patches, from half an inch 
to an inch in diameter, most generally on the lower extremi- 
ties. When more fully developed they are slightly elevated 
above the adjacent skin, and in a few days form small, red, 
painful tumors, which seem inclined to suppurate, and in 
severer cases give a suspicious sense of fluctuation, but at last 
disappear without any change of structure. The first form 
may last but a few hours, or in rare cases it may continue two 
or three weeks; the second usually continues for from three 
to six days. 

Treatment. — But little treatment is needed in the simple 
form of the disease. The bowels may be opened by equal 



538 The Eclectic Practice of Medicine. 

parts of Compound Powder of Rhubarb, and Compouad 
Powder of Jalap, or with the first alone; or if there is no 
occasion for this, we may give, #, Syrup of Rhubarb and 
Potassa, f3jss; Essl. Tincture of Asclepias, f3ss; M., and to a 
child two or three years old we may give half a teaspoonful 
every hour or two, or to an adult, one or two teaspoonsful 
frequently. The surface should be bathed with a weak solu- 
tion of Carbonate of Potassa, and in some cases w T e would 
use the warm foot bath. In the second form of the disease, 
I have usually prescribed a gentle laxative, with a solution of 
Acetate of Potassa, and very small doses of Aconite. The 
use of the alkaline bath gives great relief, and it may some- 
times be repeated several times a day. In some rare cases 
there seems to be a tendency to excoriation, and in such case 
I would advise a lotion of, #, Glycerin, f3j ; Chlorate of 
Potassa, gr. xx; Aqua Rosoe, fgij; M. 

Erysipelas. 

Erysipelas is undoubtedly a disease of the blood, and should 
be classed with the eruptive fevers, though not contagious, 
except in exceptional cases. It may occur at any age, though 
it is more frequent in adults than in children. The causes 
of erysipelas are obscure, though it is probably occasioned by 
cold, arrest of secretion, etc., as in other forms of fever. It 
occurs most frequently in the spring and autumn, and in per- 
sons of a fine delicate skin. Occasionally it becomes epidemic 
in a neighborhood or section of country, and in other cases 
highly contagious, as in large hospitals. I have known surgeons 
that had to suspend all operations, even the most simple, on 
this account, for weeks, as almost every case operated on 
would have erysipelas. We distinguish these forms of this 
disease, E. verum, E. phlegmonodes, E. gangrenosum. 

Symptoms. — 1. Erysipelas Verum. — Frequently the disease is 
preceded, or in other cases shortly followed, by a well-marked 
chill, to which succeeds febrile action. In some cases the 
fever is slight, but in others it is as intense as in the contin- 
ued fevers. "With the commencement of the chill a circum- 
scribed redness of some portion of the skin comes up, and in 
a few hours becomes slightly swollen, hot and painful. The 
redness is generally deep, but is effaced by pressure, though 
from the exquisite tenderness of the part, the patient will 
rarely permit it. As the disease continues, it usually extends 



Erysipelas. 



539 



slowly to adjacent parts, the advance of the inflammation 
being marked by slight swelling, pain and tenderness on 
pressure. In this way, commencing as a small spot on the 
face, it sometimes extends until it involves the entire face 
and scalp. 

Frequently in the course of two or three days the epidermis 
is loosened and distended with a yellowish serum, forming 
bullae of larger or smaller size, and these rupturing pour out 
their secretion, and sometimes become covered with thin 
incrustations. The redness usually fades, and the inflamma- 
tion commences to disappear by the fifth or sixth day, leaving 
the epidermis wrinkled and yellowish, and at last it desqua- 
mates over the entire surface. This form of erysipelas may 
appear upon any part of the body, but is far more frequent 
upon the face and extremities. The fever is in some degree 
dependent on the extent of the eruption, though in severe 
cases where this is comparatively slight it will be very severe 
and of a low asthenic form; delirium sometimes occurs where 
the face and scalp are affected. 

2. Erysipelas P1ilegmonod.es. — This variety affects not only 
the skin, but the cellular tissue, and in some cases, the entire 
structure of a part, and is proportionally more severe. It 
results more frequently from injuries, as bruises or punctured 
wounds, but may be idiopathic; it occurs most frequently in 
the extremities. In many cases the disease is ushered in with 
a chill, to which succeeds febrile action. Occasionally the 
fever is very intense, the tongue becoming dark coated, the 
pulse hard, small, and frequent, the bowels irregular, urine 
scanty, high-colored and foetid, with low muttering delirium. 
The local disease comes up as in the other case, with heat, 
pain and redness, but it is soon observed that the swelling is 
much more marked. "When the disease is fully developed the 
pain is intense, and the patient can not bear the slightest 
pressure on the part, which seems to be swollen to its fullest 
extent. In the course of from three to five days, the redness 
and heat subside, and the part gives a doughy sensation to the 
touch, and is if anything more swollen and painful. Small 
purulent deposits are' now noticed, which upon being opened, 
at first discharge a healthy pus mingled with flakes of broken 
down cellular tissue, and afterwards in some cases, a reddish 
flocculent material. When the disease has been severe, a 



540 The Eclectic Practice of Medicine. 

large portion of the cellular tissue will have lost its vitality, 
and will be discharged in this manner, recovery being slow. 

3. Erysipelas Gangrenosum. — This form usually occurs in 
persons of broken down constitutions, or where the health 
has been impaired by previous disease. It may come up as in 
the preceding case with severe constitutional and local symp- 
toms, but more frequently these are mild. The swelling is 
usually very marked, and in a short time the surface is 
observed to become of a dusky-red, or almost black color, 
phlyctense appear, and the inflammation soon terminates in 
gangrene. With the appearance of these symptoms, the fever 
frequently assumes a low typhoid form, with muttering delir- 
ium, dark-brown tongue, diarrhoea, etc., and if the disease 
is extensive, soon terminates fatally. 

Diagnosis. — The symptoms of erysipelas are so well marked 
that it can not well be mistaken for any other disease. The 
deep, circumscribed redness, burning pain, swelling and heat, 
and the severe constitutional disturbance, are its distinguish- 
ing features. Erysipelas of the face, its most common situa- 
tion, will commence in a spot not larger than a dollar, and 
will gradually spread until it involves a large portion of the 
integument, the swelling being so great as to almost entirely 
obscure the features. On the extremities it may be limited 
and the symptoms mild, but frequently commencing on a 
limb it will extend up or down, until a considerable portion is 
involved, the tumefaction being so great as to entirely 
change the appearance of the limb. 

Prognosis. — Erysipelas will terminate favorably in a large 
majority of cases, if properly treated. It becomes dangerous 
where a large portion of the integument is involved, with 
severe constitutional disturbance; where the tongue becomes 
dark, with diarrhoea, and great prostration ; where inflamma- 
tion of the brain occurs during erysipelas of the scalp; and in 
severe cases of phlegmonous, and in the gangrenous form of 
the disease. 

Treatment. — We would immediately put a patient on the 
use of the special sedatives, Tinctures of Aconite and Vera- 
trum, in the doses heretofore recommended, associating with 
them, as soon as the pulse was to some extent reduced, I&, 
Essl. Tincture of Asclepias, f 3j ; Carbonate of Ammonia, 3ss; 
Aqua, 3ij ; M., and administer in doses of a teaspoonful every 
two hours. If there is nausea, or evidence of accumulations 



Erysipelas. 



541 



in the stomach, a thorough emetic should be given. A gentle 
cathartic, as the Compound Powder of Jalap and Senna, or 
the Podophyllin Pill, may be given to keep the bowels open, 
though brisk purgation is to be avoided. By the second or 
third day, the fever being controlled by these means, we 
would give Quinia, associated with Hydrastin or Prussiate of 
Iron, in the usual doses. In addition to this, we would com- 
mence at first the administration of the Tincture of Muriate 
of Iron, giving it in doses of from ten to forty drops largely 
diluted with water, every two or three hours, and continuing 
it until the disease had disappeared. If there is a specific in 
medicine, this remedy is one in erysipelas, and we might 
safely rely upon it in many cases without other means. 

As regards local applications, we generally apply the Tinc- 
ture of Muriate of Iron, either pure or combined with an 
equal part of Glycerin. It should be used with a camel's 
hair pencil, or brush made of soft cotton cloth, painting the 
entire part, and for a considerable distance outside the red- 
ness; if any part should be vesicated, it should not be 
touched with the remedy. Applying it this way every three 
or four hours, we would in the meantime keep the part cov- 
ered with a cloth wet with #, Tincture of Muriate of Iron, 
f3j; Glycerin, 3iij; M., or a cloth wet with sweet or Linseed 
oil, or fresh Lard. Some practitioners employ a strong solu- 
tion of Mtrate of Silver, forty or sixty grains to the ounce of 
water, and some cauterize the sound skin entirely around the 
inflamed part with the stick Nitrate of Silver; though it 
answers a good purpose in some cases, I do not like the treat- 
ment as well as the preceding. 

Occasionally we find a case in which the patient can not 
bear the slightest irritant, and the measures just named seem 
to increase the disease. Here we may use the Glycerin alone, 
or fresh Lard, or equal parts of Lime water and Linseed oil. In 
some very obstinate cases I have used a decoction of the inner 
bark of the common Elder, boiled in buttermilk, and a poul- 
tice of a strong decoction of Cornus with "Wheat bran. 

In phlegmonous erysipelas we may employ the means above 
named until evidence of suppuration presents itself, when the 
part should be immediately opened. In some cases the first 
appearance of suppuration manifested by throbbing, or 
extreme and unnatural swelling and tension of the part, calls 
for free incisions. We may anticipate the suppurative pro- 



542 The Eclectic Practice of Medicine. 

cess, but we give relief and mitigate the severe, constitutional 
disturbance, and sometimes thus save the life of the patient, 
or the use of the limb. There can be no doubt but that the 
only successful plan of treatment in some cases of gangrenous 
erysipelas is the free use of the knife, followed by the topical 
application of a solution of Sulphate of Zinc. Suppuration 
having been established, it has been my practice to syringe the 
openings with a solution of Sulphate of Zinc, ten to thirty 
grains to the ounce of water, and use equal parts of Tinc- 
tures of Arnica, Stramonium, and water as a dressing. If the 
fever should assume a typhoid character during the disease, 
we would treat it in a similar manner to typhoid fever. As 
an antiseptic and diaphoretic combination I have used, #, 
Chlorate of Potassa, 3ij ; Hydrochlorate of Ammonia, 3j ; 
Tincture of Asclepias, f3ss; Aqua, f3iijss; M., and give in 
teaspoonful doses every two hours. An infusion of Baptisia, 
or of this and Bayberry, sometimes answers a good purpose; 
Quinia and Hydrastin should be used in moderate doses, and 
stimulants given to sufficient extent to keep up the strength 
of the patient. It must not be forgotten that the patient 
needs food, and as much of animal broths or of milk should 
be given as the stomach can appropriate. If at any time 
nausea and vomiting sets in, so that the patient can not take 
the necessary medicine and food, we will have to administer 
an emetic, unless in those exceptional cases, in which there is 
inflammation of the stomach, when the soothing measures 
heretofore named should be employed. 

Roseola. 

Eoseola, or rose-rash, is a'mild exanthematous eruption con- 
tinuing from one to six or seven days, and attended by more 
or less febrile action. The causes are obscure, though arrest 
of secretion and gastro-intestinal irritation, are the most fre- 
quent. It sometimes occurs as an epidemic, especially in warm 
seasons, and sporadically, from over-heating the body, severe 
exercise, etc. Four varieties have been distinguished. R. 
infantilis, R. cestiva, R. autumnalis, and R. annulata. 

Symptoms. — Roseola infantilis, as its name indicates, is 
usually met with in young children, and arises from gastro- 
intestinal irritation, or from dentition. It come3 out in the 
form of deep rosy-red patches about one fourth of an inch in 
diameter, and circular in form. When severe, they are very 



Eoseola. 543 

much crowded together so as to give a general red appearance 
to the surface, but yet each one is well defined. They may 
continue for several days, or vanish and reappear for several 
days. Usually the fever is hut slight, but the child shows 
symptoms of irritation, being cross and fretful. 

Eoseola oestiva is usually ushered in by marked febrile action, 
and in children delirium or convulsions sometimes supervene. 
The eruption usually appears about the third or fourth day on 
the face and neck, and in a few hours involves the greater 
part of the body. "The spots are of a deep red color, more 
irregular in shape than those of measles, and their original 
color soon passes into a light rosy hue. There is also present 
a considerable degree of itching and pain, and often difficulty 
in swallowing." The disease runs a very variable course, but 
the eruption usually disappears in three or four days without 
desquamation. 

Roseola annulata, comes out in the form of rose-red rings, 
in the center of which the skin retains its natural color; it is 
said to be principally observed on the abdomen and buttocks. 
It is not usually accompanied with much fever, but is occa- 
sionally very persistent, and is usually associated with gastro- 
intestinal irritation. 

Diagnosis. — Eoseola may be distinguished from measles by 
the spots being larger, circular, circumscribed, and of a deep 
rose color, whilst, the patches of measles are small, irregular, 
and of a bright red color. The eruption of scarlet fever, con- 
sists of a great number of small red points of a scarlet or 
raspberry color, and grouped together so as to form irregular 
patches. 

Treatment. — But little treatment is necessary in many cases 
of this disease, as it passes through its various stages, with 
but slight disturbance. Usually we prescribe for a child, #, 
Compound Syrup of Ehubarb, fSjss; Essl. Tincture of 
Asclepias, f 3ss ; M., and give in teaspoonful doses every hour 
until it moves the bowels. Occasionally the stomach is very 
much out of order, when we give a mild emetic. In the 
severer cases, I would administer the special sedatives to arrest 
the fever, with Tincture of Gelseminum to quiet nervous irri- 
tation, and direct the alkaline bath to be used once or twice 
daily. 



544 The Eclectic Practice of Medicine. 

Urticaria. 

Urticaria or nettle-rash occurs most frequently in childhood, 
though we occasionally see cases of it in the adult. The 
most common cause is doubtless gastro-intestinal irritation, 
though the milder forms may be caused by sudden changes 
of temperature, or excessive mental emotion. Sometimes it 
is an acute affection, but more frequently it assumes a chronic 
form, and may last for months or years, reappearing on the 
slightest imprudence of diet or change of habits. 

Symptoms. — Though divided into several varieties, it will 
suit our purpose to consider it as febrile and non-febrile. In 
the first case the eruption is preceded for a day or two by 
slight febrile symptoms, irritation of the stomach, and pain 
at the epigastrium. The eruption then comes out in the form 
of red or pale red blotches, irregular in shape, elevated above 
the adjacent skin, hard around their edges, and surrounded 
by a bright red or scarlet border. An intolerable pruritus 
and burning accompanies the eruption, aggravated by warmth, 
and usually by scratching or rubbing the part, and is some- 
times so severe as to prevent the patient's sleeping. The 
eruption is not constant, but goes away and reappears some- 
times every few hours. The disease usually continues for 
seven or eight days, with some constitutional disturbance 
during the entire period, and at last disappears, leaving but 
slight itching; in severe cases there may be some desquama- 
tion. 

The non-febrile form is usually chronic, and has been 
divided into two varieties, U. evanida and U. tuberosa. In 
the first, the eruption appears at irregular intervals, some- 
times for months or years, is not attended by febrile action, 
and has not the red border just noticed; the spots look more 
like those produced by whipping, and are only accompanied 
bv itching. 

The last form is very rare, and instead of the slightly ele- 
vated blotches, there are broad, hard, deep-seated and painful 
tuberosities which impede motion. It passes off and reappears 
like the preceding variety, but almost always leaves the 
patient fatigued and depressed. 

Diagnosis. — There is but one disease (lichen urticatus) with 
which this can be mistaken, and from that it may be distin- 
guished by the large irregular blotches, while in lichen, the 



Vesicul^;. 545 

papulae are rounder, less prominent, smaller, harder, and of a 
deeper color. Urticaria may be complicated, however, with 
erythema, roseola, impetigo and lichen. 

Treatment. — In the febrile form of this disease, if there is 
marked derangement of the stomach, relief will be most 
quickly obtained by the administration of an emetic, followed 
by a gentle purgative. Acidulated drinks, with small doses 
of the special sedatives, may then be given, and the surface 
should be frequently bathed with a solution of Carbonate of 
Potassa, or in some cases, water acidulated with Sulphuric 
Acid. In the chronic form of the disease, especial attention 
must be paid to the condition of the stomach and bowels, and 
to the diet. In children, the occasional use of the Syrup of 
Rhubarb and Potassa, with Essl. Tincture of Asclepias, will 
prove useful. In the adult, we will obtain more benefit, in 
persistent cases, from the use of the Compound Tincture of 
Corydalis, with a solution of Acetate of Potassa. In very 
stubborn cases we may give a solution of Bromide or Iodide 
of Ammonium, with a decoction of equal parts of Alnus and 
Rumex. 

Rubeola and scarlatina have been heretofore described 
under the head of eruptive fevers, and need no notice here. 



ORDER II.— VESICUL.E. 

The distinguishing characteristic of this order is, the forma- 
tion of small vesicles by an elevation of the epidermis, which 
are filled with a serous fluid. This fluid at first transparent, 
in severe cases becomes yellowish and opaque, and is finally 
either absorbed, or dries and forms scales or incrustations. The 
vesicle is always round, and may or may not stand upon an 
inflamed base. One variety of this order, varicella, has already 
been described with the eruptive fevers. 

Milaria. 
Milaria, or sudamina most generally appears as an attend- 
ant upon other diseases, more especially typhoid, and the 
advanced stages of other fevers and inflammations. There 
are exceptional cases "in which it assumes an idiopathic form, 
as for example, when it appears in healthy subjects after 
violent exercise in warm weather ; in these instances it is gen- 
35 



546 The Eclectic Practice of Medicine. 

erally accompanied with copious perspiration. The eruption 
is then attended with a disagreeable sensation of heat and 
itching. The number of vesicles is sometimes very consider- 
able, but they are ephemeral, and disappear in the course of 
twenty-four hours. " — (Cazenave.) The miliary vesicle is 
small, not larger than a pin's head, and the contents being 
clear and transparent, it can not be seen well unless we look 
across the surface. They are usually grouped together in 
patches, upon the thorax and neck, and in rare cases become 
confluent, forming bullse. They demand no treatment, being 
simply symptomatic of other diseases. 

Eczema. 

Eczema, humid tetter, or running scall, is characterized by an 
eruption of small vesicles grouped and crowded together, and 
forming more or less well defined patches. It may be divided 
into the acute and chronic form, and these have to be still 
further divided into several varieties. The causes of eczema 
are very obscure, and it is non-contagious, except in rare case s 
when the disease affects the genital organs. 

Symptoms. — Eczema simplex commences with a sensation of 
itching, which is soon followed by the appearance of numer- 
ous small transparent vesicles, flattened, and set close together; 
after a time the fluid they contain becomes opaque, and they 
finally rupture, forming a small thin scab which is soon 
detached. They appear more frequently upon the fore-arm, 
and where the skin is thin and delicate, and frequently 
between the fingers, somewhat resembling the itch. 

Eczema rubrum is accompanied with considerable heat and 
tension of the skin, and at first the vesicles may be observed 
as small solid points, but they soon become true vesicles, 
which attain the size of a pin's head, and finally disappear 
about the sixth or eighth day. In some cases the vesicles 
coalesce and rupture, a disagreeable excoriation producing 
repeated incrustations being left. 

In eczema impetignodes the inflammation of the skin is very 
marked and it is swollen, the vesicles are larger, and the con- 
tained fluid loses its transparency and becomes purulent, and 
finally they rupture, forming a scab, which is thrown oft' and 
re-formed sometimes for two or three weeks. Acute eczema 
of the two last forms is usually attended with well marked 
febrile action, which continues for two or three days, and 



Eczema. 547 

sometimes for a longer period. The eruption is always 
accompanied by itching, which is sometimes very severe and 
troublesome. 

Chronic eczema most generally results from an acute attack, 
and may continue for months, or even years. In these cases 
the skin becomes deeply inflamed and excoriated, and fissures 
form about the joints; a continued ichorous discharge is kept 
up which increases the irritation, and forms thin crusts, or 
coming in contact with the clothing agglutinates it to the part, 
and when removed there is much pain and smarting, and 
sometimes a considerable flow of blood. "When the crusts are 
detached, the surface is found reddened, soft and swollen. In 
other cases there is less exudation, the skin being dry, inflamed 
and fissured, and covered by slight crusts. " Chronic eczema 
is invariably attended with intense itching, more distressing 
than the severest pain. The patient in vain struggles 
against it, but he can not, however, resist the urgent desire 
to scratch himself, and thus increases his suffering. After a 
certain period, the itching begins to subside, the serous exuda- 
tion gradually ceases, the scaly incrustations dry up, and the 
skin is less] inflamed. Finally the disease becomes reduced 
to a small, dry, red surface, which is covered with extremely 
thin, laminated crusts. The surrounding skin is smooth, 
tense and firm, and only slowly resumes its natural state." — 
(Cazenave.) 

Diagnosis. — It may be distinguished from itch by the flat- 
ness of the vesicles, their being grouped together, whilst in 
itch they are pointed and isolated. The diagnosis of chronic 
eczema from lichen is sometimes difficult, but usually the 
presence of papulae near the red inflamed surface is sufficient. 

Treatment. — In acute eczema we would administer a laxa- 
tive, and give the patient a solution of Citrate or Acetate of 
Potassa, with lemonade. If there is much febrile action, we, 
would associate with it small doses of the special sedatives. 
The alkaline bath, frequently repeated, is the only external 
application that is necessary. In the severer forms we may 
use a lotion of #, Chlorate of Potassa, 3ij ; Morphia, gr. ij ; 
Glycerin, 3ij; Aqua Rosse, 3iv; M., and apply three or four 
times a day. 

In chronic eczema, we will give the patient a vegetable 
alterative, as the Compound Tincture of Corydalis, or an 
infusion of equal parts of Alnus, Eumex, and Jeffersouia, 



548 The Eclectic Practice of Medicine. 

associated with the simple bitter tonics if they should be 
deemed necessary. In addition to this, a solution of Acetate of 
Potassa in the usual doses, or Liquor Potassa in doses of from 
ten to forty drops should be given. The alkalies, and the 
vegetable remedies above named seem to exert a marked 
influence on the disease. The bowels should be kept open by 
gentle laxatives, though purgation should be avoided. As a 
local application we may use the Glycerin lotion above named, 
or we may employ an infusion of Alnus and Eumex, followed 
by Glycerin, or what is better than either, an ointment of the 
inner bark of the common Elder. In some cases a general 
bath, rendered emollient by the addition of Mucilage or Gela- 
tin, will be beneficial; it should be about 90° Fahrenheit, 
and continued for an hour or longer. In place of this we 
may use the vapor bath, repeating it two or three times 
weekly. 

Herpes. 

Herpes is most generally an acute disease, and is character- 
ized by an eruption of vesicles grouped together on an 
inflamed base. The causes are unknown. Five varieties are 
distinguished: H. phlyctenodes, H. labialis, H. praaputialis, 
H. zoster, and IT. circinatus. 

Symptoms. — Herpes phlyctenoides is usually attended by 
slight indisposition, loss of appetite and constipation. The 
patient feels a smarting, burning sensation of some part, and 
upon examination finds a number of slightly red spots, upon 
which in a short time is developed six or eight firm and prom- 
inent vesicles from the size of a millet seed to that of a small 
pea. At first they are transparent, but in the course of a day 
become opaque and milky; there is frequently a sensation of 
itching, and sometimes the part feels quite painful. They 
commence to decline about the fourth or fifth day, drying up 
and leaving larger or smaller incrustations, and by the eighth 
or tenth day they have entirely disappeared, nothing but the 
redness of the surface remaining. 

Herpes labialis is usually preceded by slight indisposition 
and fever, and hence the vesicles are often termed fever blisters. 
It usually comes out at the junction of the skin and mucous 
membrane, but may appear in the mouth, or as far back as the 
pharynx. It is usually preceded for a few hours by redness, 
and sometimes the part is swollen and painful. The vesicles 
are of various sizes, the largest about the size of a small pea; 



Herpes. 549 

at first they are transparent, but in two or three days become 
opaque and yellow, and in two or three days more desiccate, 
forming brownish crusts. * 

Herpes prceputialis appears on the external surface of the 
prepuce, small inflamed spots being first noticed, which in the 
course of a few hours are covered with groups of small glo- 
bose vesicles. It runs a similar course to that just noticed, 
but in some cases continues to reappear for years, causing 
great annoyance to the patient. 

Herpes zoster or shingles is usually the severest form of the 
disease, being attended in many cases with marked febrile 
action. It usually makes its appearance on the trunk in irreg- 
ular patches of a red color, which are soon covered with vesi- 
cles ; new patches coming up, the disease may pass entirely 
round the body, though Cazenave states that it never appears 
but upon one side at a time. The vesicles resemble those 
already described, but are sometimes larger; they usually dis- 
appear in four or five days, leaving at some points thin, brown 
incrustations which are soon detached. The disease usually 
lasts for ten or fourteen days, and sometimes longer. 

Herpes circinatus or ringworm, appears most frequently upon 
the face, neck and arms, though it may come out on any por- 
tion of the body. It comes out at first as a red spot about 
the size of a dime, on which shortly appear numerous small 
vesicles arranged in rings, hence the common name of ring- 
worm; it is not attended with constitutional disturbance, and 
generally disappears in ten or twelve days.. 

Diagnosis. — The diagnosis of herpes is generally easy, the 
vesicles being round, prominent, and grouped together on one 
inflamed or red base; the symptoms of the different forms 
are usually sufficiently marked for their easy distinction, as 
above described. 

Treatment. — But little if any treatment is necessary in 
many of these cases. If there is febrile action, as in H. 
phlyctenodes and II. zoster, we would direct the use of the 
alkaline bath, the hot foot bath, and prescribe small doses of 
the special sedatives, with a solution of Acetate of Potassa. 
If there is much irritation of the part, a lotion of Glycerin 
and Chlorate of Potassa, as heretofore recommended, will be 
useful. Herpes prseputialis is sometimes a very stubborn dis- 
ease: we prescribe for it a lotion of Borax and Morphia, the 
Glycerin lotion, equal parts of Glycerin and Muriated Tine- 



550 The Eclectic Practice of Medicine. 

tnre of Iron, or a decoction of equal parts of Cornus, Alnus 
and Rumex. Herpes circinatus may sometimes be arrested 
by painting the part with Tincture of Muriate of Iron or 
Tincture of Iodine; but usually the Glycerin lotion will be 
sufficient. 

Scabies. 

Scabies or itch, though a vesicular disease, is produced by 
an animal parasite — the aearus scabiei — and hence, as this 
insect possesses a very tenacious vitality, the disease is rend- 
ered contagious by its transmission from one to another. The 
aearus is usually found a short distance from the vesicle in a 
small furrow leading from it. With good sight or a magnifying 
glass it can be seen as a small, round, grayish body, sometimes 
moving, sometimes at rest. Under the rnicroscope,*its body 
is seen to be oval, the back convex and marked with curved 
lines, its head covered with fine hairs, and eight legs passing 
from its abdomen. The insect passes from one part to another, 
by burrowing under the epidermis, but is only conveyed to dis- 
tant parts by the fingers, after scratching, and by the clothing. 

Symptoms. — Scabies almost always makes its first appearance 
between the fingers and front part of the wrist, in the form 
of small pointed vesicles, containing a clear, limpid fluid, and 
a very fine line leading from it, and marking the situation of 
the aearus. An intense but pleasurable sensation of itching 
attends their appearance, and the patient can not resist the 
inclination to scratch or rub the part, though this sometimes 
gives rise to a sensation of smarting if too severe. As the 
disease progresses, the irritation of the skin by the nails usu- 
ally produces suppuration in the vesicles, the result being the 
formation of larger or smaller scabs, and some inflammation and 
stiffness of the skin. In severer cases we occasionally see in 
the interspace between the fingers a large festering surface cov- 
ered with thick scabs, and the hands so stiff* and painful that 
they can hardly be used. Sometimes the itch is confined to 
the hands, but in others it is conveyed to the flexures of the 
joints, to the perineum around the anus, and in fact wherever 
the skin is thin and delicate. In all these situations we may 
have the suppurative action above named, so that occasionally 
instead of a mild vesicular disease, the patient will be cov- 
ered with foul, painful, ulcerating sores. 

Itch never terminates spontaneously, but may last for years . 



Scabies. 551 

In some cases it never passes the vesicular form first named, 
but in a majority, especially where cleanliness is neglected, it 
goes on to the formation of hard scales, and induration of the 
skin. 

Diagnosis. — The diagnosis of itch is generally not difficult, 
as the vesicles are pointed and solitary, while in eczema they 
are flattened, and in prurigo the eruption is first papular, as it 
is also in lichen, and in neither case does it appear between 
the fingers, the frequent seat of scabies. The sulcus passing 
from the vesicle in itch is a good diagnostic feature, though 
not usually very well marked. In the severer stages of the dis- 
ease, there would be difficulty in the diagnosis were it not for 
the constant reappearance of the disease in its original form. 
Treatment. — The object of treatment is to destroy the itch 
insect, and whatever will accomplish this with the greatest 
certainty, and in the least time, will prove the best remedy. 
Sulphur has formed the basis of most applications, and is I 
believe the best remedy. "We may use it in the form of oint- 
ment mixed with Lard, or with an Alkali, as, #, Sulphur Sub. 
3ij; Sub-carbonate of Potash, 3j; Lard, 3viij; M.; or, #, Prepared 
Chalk, 3iv; Sulphur, Tar, aa, 3vj; Soft Soap, Lard, aa, 3xvj; 
M. These ointments should be thoroughly applied to the 
parts affected, after they have been well cleansed with soap 
and water. I have used a combination of, #, Sulphuret of 
Potassium, 3ss; Oils ot Eosemary and Lavender, aa, 3j; Lard, 
3vj; M.; and apply as before. Cazenave states that after 
repeated trials they determined that the two following formula 
yielded the most satisfactory results, #, Essence of Pepper- 
mint, Rosemary, Lavender and Lemon, aa, gtt. iv to gtt. vj ; 
Alcohol, 3jss; weak infusion of Thyme, Ovj; it was freely 
used, and the cure resulted in eight days. #, Iodide of Sul- 
phur, Iodide of Potassium, aa, 3jss; Water, Oij ; the mean 
duration being six days. They say, whatever the lotion 
employed, it is necessary not only to wet the affected parts, 
but to prolong its application, so as to produce that kind of 
maceration which is required to destroy the insect. A solu- 
tion of Sulphuret of Lime, 3ij to the pint of Water is very 
efficient, the cure being effected sometimes with three or four 
applications. 

In the milder forms of the disease no internal treatment is 
necessary, but the patient should be guarded against cold, 
dampness, and sudden changes of temperature, and have his 



552 The Eclectic Practice of Medicine. 

entire under clothing changed every day. In the more per- 
sistent cases, we may give equal parts of Sulphur and Cream 
of Tartar, to the extent of keeping the bowels open, and in 
some cases where the patient is cachectic, the bitter tonics 
and Iron. I have cured the itch with a local application of 
the Phytolacca, and Podophyllum, but I prefer the remedies 
first named. 



ORDER III.— BULLAE. 

This order, it will be recollected, is characterized by the 
formation of large blebs or blisters, from the size of a pea to a 
hen's egg, sometimes with and sometimes without redness of 
the skin. Properly speaking, there is but one variety, pem- 
phigus, but some authors class rupia under this order. Both 
affections are usually chronic, and may appear in succession, 
on any part of the body. We have no knowledge of their 
causes further than they are usually associated with a cachec- 
tic condition of the system. 

Pemphigus. 

Pemphigus is almost always associated with general debility 
and imperfect performance of the various functions of diges- 
tion, assimilation and secretion, though the person may seem 
to enjoy tolerably good health. It makes its appearance in 
the form of blebs or blisters, from the size of a split pea, to 
an inch or more in diameter, containing a thin transparent 
serum. They frequently increase in size for two or three 
days, the fluid becoming straw-colored, when they arc rup- 
tured, and a thin brownish crust forms. Sometimes the sur- 
face heals at once, but at others these crusts are reproduced for 
several days or even weeks. 

Diagnosis. — The diagnosis is always easy when they first 
appear, as in no other skin disease do we see such a large 
elevation of the epidermis. "When they have ruptured the 
diagnosis is more difficult, but it may usually be distinguished 
from other affections by the brown thin scab, and by the dark 
red irregular spot when it is removed. 

Treatment. — The treatment of this affection resolves itself 
into that which will most quickly restore the general health. 
In children I have prescribed, #, Syrup of Rhubarb and 
Potassa, fgjss; Essl. Tincture of Asclepias, fgss; M., and give 



Eupia. 553 

in closes of a teaspoonful every two or three hours. Associ- 
ated with this I would administer Quinia, Hydrastin and Iron 
in suitable doses. In some cases the alkaline diuretics in 
small doses, are very useful, removing as they do the detritus 
of the system. If there is much derangement of the system, 
the treatment should be premised with an emetic. Strict 
attention should be given to the skin, by the use of a daily 
bath, using an alkaline solution, or salt water, or if there 
was feeble circulation, a stimulant bath of Mustard or Capsi- 
cum. If the bullae are large, and the surface painful when 
they rupture, it may be dressed with equal parts of Lime 
water and s Linseed oil, or powdered Elm, Flour, or Hydrastin 
may be sprinkled on it to absorb the discharges. 

Eupia. 

This, like the preceding disease, is almost always associated 
with a cachectic condition of the system, and enfeebkcl vital- 
ity, and appears most frequently among the poor, destitute 
and ill-fed, though occasionally when the patients have all the 
comforts and luxuries of life. Its only relation to the preced- 
ing disease, or to this order, is in its first appearance, and it 
soon loses this resemblance. It is always a chronic affection, 
lasting from two or three weeks to many months. 'Three 
varieties are distinguished, E. simplex, E. prominens, and E. 
escharotica. 

Symptoms. — JRupia simplex appears in the form of bullae, 
about the size of a dime, round and flattened, and without evi- 
dence of inflammation. The contained fluid is at first a 
limpid serum, but it soon becomes opaque and purulent, and 
finally concretes, forming thick flat crusts, of a brownish color. 
These fall off in a few days, leaving a superficial ulcer of the 
skin, which soon cicatrizes, but a livid-red color remains for 
some time afterwards. 

JRupia prominens makes its appearance in a similar manner, 
but the bullae are frequently larger, and the ulceration deeper, 
and the scales thicker. Usually the skin is reddened, and 
sometimes there is a burning sensation and pain. The scab 
seems to grow, in many cases, by continued additions at the 
base, and becomes one-fourth or even half an inch in thickness, 
and conical, and resembles to some extent, a snail's shell. 
"When the scab is removed, a new one frequently takes its 
place, and they may be thus re-formed for months. In some 



554 The Eclectic Practice of Medicine. 

cases the ulcer is healed with difficulty, the edges being livid 
and tumified, the center pale, and bleeding on slight pressure. 
Rupia escharotica occurs most frequently in children up to 
two years of age. It commences with the appearance of 
slightly prominent livid patches, upon which irregular and 
flattened bullse are soon formed; when the bullce break, ulcer- 
ated surfaces are left which secrete a disagreeable unhealthy 
pus. " The infant suffers from acute pain, much fever and 
insomnolency. "When the disease assumes an intense form, 
death may ensue in one or two weeks. When it does termi- 
nate favorably, the ulcerations are very long in healing. " — 
(Cazenave.) 

Diagnosis. — Rupia is diagnosed with ease, in most cases, by 
the prominent, conical, brown scabs, those of pemphigus being 
flat. Ecthyma resembles it most in some cases, and it will be 
difficult to distinguish between them in its later stages, but 
the hard and inflamed base, irregular scabs, and superficial 
excoriations, are usually sufficiently diagnostic. 

Treatment. — The treatment in this disease, as in the pre- 
ceding, should be strictly tonic, arrest of the skin disease 
depending to a great extent upon the restoration of the gen- 
eral health. I have obtained the best results from the 
administration of the Compound a Tincture of Corydalis, with 
Citrate of Iron, and small doses of Quinia and Ilydrastin. If 
there is much derangement of the stomach, we frequently 
derive benefit from an emetic, and in many cases, excretion 
needs to be stimulated with small doses of the alkaline diur- 
etics. Associated with these means, the patient should have 
a daily bath of salt and water, or in some cases of a decoction 
of Cornus or Hydrastis. The diet should be nutritious, and 
exercise should be taken in the open air. 

When the local affection is very persistent, we may dress 
the ulcer with three parts of Glycerin, and one of Tincture 
of Muriate of Iron ; or with the mild Zinc Ointment, Black 
Salve, or an ointment made of the inner bark of the Elder. 
Sometimes a decoction of equal parts of Cornus, Alnus and 
Rumex, answers an excellent purpose, or the tinctures of the 
same agents may be used. When the ulcers are very persis- 
tent they may be cauterized with a saturated solution of 
Chloride of Zinc, or a paste made with this and Hydrastis; 
after the slough is cast off*, the part usually heals kindly with 
any simple dressing. 



PuSTFLiE. 



555 



ORDEK IV.— PUSTTTL^E. 

This order is distinguished by the formation of small eleva- 
tions containing pus, and hence termed pustules. They are 
almost invariably situated on an inflamed base, which usually 
precedes the eruption, though in some cases the inflammation 
comes on after the appearance of the eruption, and is more 
or less diffused. The diseases included under this order are 
both acute and chronic, two of them, variola and vaccinia y 
heretofore described, being eminently contagious, and one, 
porrigo, being propagated by contact. The others seem to 
depend upon some unknown internal cause. 

Ecthyma. 

Ecthyma may be divided into the two forms, acute and 
chronic, the first occurring most frequently in children and 
young persons, the second in the adult, though sometimes in 
children. 

Symptoms. — In the acute form it is usually preceded by las- 
situde and indisposition, and its appearance is frequently 
marked with slight chills and febrile action. It makes its 
appearance in the shape of red, circumscribed, inflamed spots, 
which soon suppurate at their apices. In some cases the erup- 
tion is attended with pain, the inflammation being quite 
severe, but in others it is simply a sense of stiffness. Some of 
the pustules terminate by resolution, whilst others are suc- 
ceeded by a thick, adherent scab, which in falling off, leaves a 
deep red mark, and in some cases a cicatrix. It usually lasts 
for one or two weeks. 

In chronic ecthyma there is a successive appearance of the 
eruption, sometimes for months, the general health being 
much depressed. It may present the same character as that 
just described, or it may become confluent in large suppu- 
rating surfaces. A variety termed ecthyma cachecticum, 
occurs in old persons and those who have broken their sys- 
tems down by intemperance. "The skin is inflamed and 
more swollen than in the common forms of the disease. It 
assumes a deepened color, and in about six or eight days the 
cuticle is raised over the pustule, is blackish, and infiltrated 
with blood. It soon bursts and forms a thick, dark scab, 
raised at the center; the edges are hard, callous, and more or 



556 The Eclectic Practice of Medicine. 

less inflamed. The scabs are very adherent, and do not 
become detached for several weeks, sometimes for months. 
If they fall accidentally, an unhealthy ulceration ensues, and 
the scab is with difficulty removed. Sometimes febrile symp- 
toms precede or accompany the eruption, but they generally 
disappear with the disease." — (Cazenave.) 

Diagnosis. — Ecthyma is usually recognized with ease by the 
hard and inflamed base, suppuration commencing on the sur- 
face, and not deep as in furunculi, acne, and sycosis, which 
are most frequently mistaken for it, but in these the base is 
hard, not inflamed, and the pustules are small and slowly 
developed. 

Treatment. — In the acute form of the disease, we would 
give mild laxatives, the special sedatives if there was fever, 
and a solution of Acetate of Potassa in full doses. The warm 
bath is sometimes useful, and may be frequently repeated. In 
the chronic form of the disease I use the alkaline diuretics 
associated with tonics, and sometimes the vegetable altera- 
tives, as the Compound Tincture of Corydalis, or an infusion 
of equal parts of Alnus and Eamex. If there is much 
inflammation and pain, emollient applications will prove ben- 
eficial. Glycerin may be used as heretofore recommended, 
and the mild Zinc and Mayer's Ointment. Occasionally the 
Tincture of Muriate of Iron forms the best local application, 
and in some, when isolated spots are very persistent, we may 
fill them with dry Sesqui-carbonate of Potash, or wash them 
out well with a saturated solution of the same. 

Impetigo. 

Impetigo has been divided into several varieties, but it will 
only be necessary to notice three of them: I. figurata, I. lar- 
valis, and I. capitis. They are all characterized by the devel- 
opment of groups of pustules which rupturing give rise to 
the formation of thick, yellowish scales. 

Impetigo figurata appears most frequently upon the face, 
though it may attack any part of the body, in young persons; 
at first as reel, slightly raised patches, upon which soon appear 
numerous pustules, scarcely raised above the skin, and nearly 
confluent. The eruption is attended with heat and itching, 
which is increased when the pustules rupture, about the sec- 
ond or third day. The fluid is abundant, and soon dries, 
forming thick, yellow incrustations which continue for one or 



Impetigo. 557 

two weeks, sometimes increasing in thickness, and when 
thrown off, a red, tender surface remains for a considerable 
time. 

Impetigo larvalis usually appears upon the face as ademp- 
tion of numerous small pustules of a light yellow color, situ- 
ated on a red surface. In a day or two they break, giving 
rise to an ichorous discharge which forms yellow or greenish, 
rough, laminated scabs. The eruption extending by new 
eruptions of pustules, it may pass over almost the entire face, 
or extend to other parts of the body. It is attended with 
considerable itching, and a sensation of burning and smarting 
when the scabs are removed. Frequently, we find the scabs 
reproduced if prematurely removed, and the surface remains 
red for sometime after it disappears. "In other cases the pus- 
tules are larger, and are developed behind the ears, round the 
mouth, upon the chin, etc., terminating in thick, yellowish- 
green crusts. In some instances the mouth is surrounded 
with large and thick, yellowish incrustations, which are of a 
deep brown color in some parts where the fiuid is mixed with 
blood. The movements of the lips are exceedingly painful in 
these cases. In other instances, again, these large incrusta- 
tions form only behind the ears. "When the disease begins to 
decline, the exudation gradually diminishes, the scabs are not 
formed so frequently, they become thin and white, their bases 
are paler, and they are soon succeeded by slight desquama- 
tion, which is not long in disappearing." 

Impetigo capitis is the severest form of the disease, and 
somewhat resembles tinea capitis, especially when severe. It 
may be confined to a small portion of the scalp, or involve 
the entire surface. It comes out in closely-set pustules, which 
rupturing, throw out a thick, viscid fluid, which mats the 
hair together, forming irregular brownish-yellow scabs. When 
the head is not properly cleansed, the hair becomes saturated 
with the secretion, and gives rise to a most disgusting smell, and 
occasionally lice accumulate, and greatly aggravate the pruritis 
and suffering. Occasionally the irritation of the scalp becomes 
so severe that small subcutaneous abscesses form and require 
opening. If the scabs arc carefully softened and removed, 
the surface is seen to be but slightly reddened, but fiom a 
vast number of pores a nauseous, viscid fluid is exuded. 

Diagnosis.— Impetigo figurata and larvalis are distinguished 



558 The Eclectic Peactice op Medicine. 

by their small, yellow pustules, thick, rough, yellowish-green 
scabs ; from porrigo or tinea favosa, it is distinguished by the 
pustules of the latter being imbedded in the epidermis, and 
terminating in umbilicated scabs. 

Treatment. — In all the varieties of impetigo, I have been 
in the habit of prescribing the Compound Tincture of Cory- 
dalis, with full doses of Acetate or Citrate of Potassa. No- 
thing, so far as myexperience extends, exerts so marked an 
influence upon the disease. Other internal treatment may be 
indicated by the condition of the patient, but will have to be 
adapted to each individual case. In all cases the general 
alkaline bath is an important measure, and its proper employ- 
ment should be insisted on. As a local application, I have 
found much benefit from the use of a lotion of, #, Glycerin, 
5ij; Oxide of Zinc, gr. xx; Morphia Sulphas, gr. v; M., and 
apply freely. An ointment made by simmering the inner 
bark of the common Elder in fresh Lard or Butter, is one of 
the best local applications that can be used. Or we may 
employ a decoction of equal parts of Cornus, Alnus and 
Eumex; or, if there is much irritation of the skin, we may 
use a poultice of a decoction of Cornus and Wheat-bran. 
In some cases emollient poultices will have to be continued 
for some time before other means can be used. In the more 
protracted cases, the Sulphur ointments, named under the 
head of scabies, may be used with good effect, though they 
frequently are of advantage in the earlier stages. 

In impetigo capitis, emollient applications should be used 
to soften the scales and remove irritation, and the head 
should be thoroughly cleansed. The local applications above 
named may then be used, or we may employ a decoction of 
Phytolacca or Cornus, or the mild Zinc Ointment. In all 
cases the hair should be cat close, and cleanliness strictly 
observed. The Sulphur ointments may be used in this case 
with advantage, and, should they not succeed, we may use 
the Oxalic Acid and Creosote wash, named under the head 
of tinea capitis. 

Acne. 
Acne occurs most frequently in persons between the age of 
puberty and thirty-five, appearing on the back and face, and 
sometimes the neck and shoulders. The causes of this affec- 
tion are very obscure, and in many cases it does not seem to 



Acne. 559 

be connected with any derangement of the general health. 
It has been divided into three varieties: A. simplex, A. indu- 
rata, and A. rosacea, which differ materially in their symp- 
toms and progress. 

Acne simplex is confined almost entirely to the young, 
appearing about the age of puberty, in the form of small 
red indurations, which soon become pustular, and are sur- 
rounded by a red areola. They are rarely painful, except 
occasionally on the face or foreheacl, and disappear with the 
formation of a thin scab, which on being removed leaves a 
slightly elevated red spot; six or eight days is usually occupied 
in their eruption and disappearance, but successive crops may 
appear for months or years. 

In acne indurata the induration is much more marked, 
and in severe cases forms livid, red, indurated tumors, which 
are painful when pressed upon. Suppuration proceeds 
slowly and small scabs are formed on the surface; in some 
cases the cellular tissue is involved and the induration remains 
for some weeks. 

Acne rosacea is most generally met with after middle age, 
and most frequently in those who have impaired their consti- 
tution by intemperance, or dissipated habits. It makes its 
appearance in the form of irregular, deep red blotches, most 
frequently on the cheeks, with slight indurations at certain 
points, upon which pustules make their appearance. In some 
persons the nose is more especially affected, the tip becoming 
bluish-red upon any indiscretion in diet, and at last perma- 
nently so, giving the face a very peculiar and unpleasant 
appearance. Small pustules form at different points, but do 
not suppurate freely. 

At last " the veins become varicose and form bluish irregu- 
lar lines, which contrasts with the intense red or violet color 
of the diseased surfaces." In some cases it passes to the 
cheeks, lips, or chin, giving the countenance a very disagree- 
able appearance. 

Diagnosis. — The slow development of the pustules, and 
their situation on a hard base, is usually sufficiently diagnos- 
tic; whilst in ecthyma, which most closely resembles it, the 
pustules are larger, never accompanied with chronic indura- 
tion, and form thick, elevated scales. 

Treatment — Acne simplex requires but little treatment. 
If the patient is very desirous of getting rid of the unpleas- 



560 



The Eclectic Practice of Medicine. 



ant appearance we would give an occasional cathartic of 
Bi-tartrate of Potassa, and a very small portion of Podophyl- 
lin, and a solution of Acetate or Citrate of Potassa. The 
entire surface may be bathed every day with cold water, and 
well rubbed with a coarse towel. For the face I usually 
recommend the Glycerin lotion. 

In acne indurata we would keep the bowels open with the 
Podophyllin Pill, and give some vegetable alterative, as the 
Compound Syrup of Stftlingia or Compound Tincture of 
Coryclalis, with Iodide of Potassium. I have obtained more 
benefit from a solution of Acetate of Potassa in some of these 
cases, than from any other remedy, and am inclined to place 
great reliance on its alterative powers. As a local application 
nothing will prove better than frictions with an ointment of 
Iodide of Sulphur, fifteen to thirty grains to the ounce of 
Lard. The common Black Salve of the Dispensatory is an 
excellent application, as is the Mayer's Ointment. 

In acne rosacea the best we can do is to recommend an 
avoidance of excesses of all kinds, that the food should be 
plain and light, and a simple Glycerin lotion applied to the 
part to relieve irritation. In some cases continued attention 
to these points, with the use of the general tepid bath, will 
result in a permanent cure, or at least the disease will be 
much mitigated. 

Mentagra. 

Mentagra, sycosis or barber' s-itch, has its seat in the seba- 
ceous follicles which are attached to the bulbs of the beard, 
and may appear on every part of the face where the hair 
grows, though most frequent on the chin and lips. It comes 
out in the form of small, red indurations at the root of the 
hair, which soon suppurates, and at length bursts, forming 
slight brown crusts through which the hair passes. When 
the eruption is extensive, both the skin and cellular tissue 
become inflamed and indurated, giving rise to considerable 
heat, stiffness and pain. The entire chin or lip will be occa- 
sionally found so involved that it seems to be a mass of dis- 
ease, nearly every hair having its suppurating pustule. It is 
essentially chronic in its character, and may last for months 
or years, and is sometimes very intractable. 

Diagnosis. — The induration at the root of the hair, and the 
manifest implication of the hair bulb and follicles, the hair 



PORRIGO. 



561 



seeming to rise out of the center of the pustule, is the most 
characteristic feature of the disease. In ecthyma the base is 
more inflamed, and the pustules larger, and in impetigo the 
pustules are in groups, while in this affection they are distinct 
and accuminated. 

Treatment. — The most successful plan of treatment that I 
have seen tried is, the internal administration of Tar and 
Sulphuret of Potassa, the bowels being kept regular, and the 
local application of the Iodide of Sulphur ointment. The 
beard should be cut with scissors, and no soap should be 
applied to the face on any account, but it should be kept clean 
by using a lotion of equal parts of Glycerin and Rose-water. 
A solution of Sulphate of Zinc has been employed in some 
cases, as has the Oxalic Acid ; the first may be used from ten 
grains to the ounce of water, to a saturated solution, and the 
second, from ten to twenty grains to the ounce of water. In 
one case of inveterate sycosis, the persistent use of a decoc- 
tion of equal parts of Alnus and Rumex, taken internally and 
applied locally, with the use of Glycerin, effected a permanent 
cure. When other means fail, if the disease is circumscribed, 
we may effect a cure by extracting the hairs with a pair of for- 
ceps. It is a painful operation, and a slow one, but very certain. 

Porrigo. 

Porrigo or tinea is a disease of the scalp, and is generally 
known by the name of scald head. It is undoubtedly conta- 
gious, and is propagated from one to another by contact ; 
hence, the necessity for care in the use of articles of clothing, 
combs, brushes, towels, etc. Two varieties are distinguished, 
P. favosa, or tinea capitis, and P. scutulata, or tinea anularis, 

Porrigo favosa commences with an eruption of minute, 
round, yellow pustules, which seem to be imbedded in the 
skin. At first they are distinct and situate on a hard base, 
but as the disease progresses they become confluent, the entire 
scalp being inflamed or indurated. In a short time after their 
formation the yellowish fluid begins to concrete, and when 
they are distinct forms a scab, with a marked depression in 
the center, but when close together, they form one large scab. 
If this is allowed to remain, it becomes thick, whitish and 
brittle; if removed, slight erosions are seen under it, and it is 
not re-formed, except by the appearance of a new crop of 

pustules. 

36 



562 The Eclectic Practice of Medicine. 

"This affection is never accompanied with febrile symp- 
toms, but a troublesome and annoying itching is often present 
during its progress, which is aggravated by want of cleanli- 
ness. A number of lice are often seen under the scabs, 
causing the patients to scratch themselves, and by this means 
increase the inflammation. In these cases there is a strong, 
disagreeable odor, similar to that of cat's urine given off from 
the head. After the head is cleansed from the scabs the odor 
becomes sickening. The excoriations on the surface, which 
often reach to the hair bulbs, and thus produce baldness, are 
not covered with the regular cup-shaped favus pustules, but 
a reddish and foetid sanies oozes out, which concretes into 
irregular-shaped scabs. Fresh pustules, however, soon appear 
which gives rise to fresh favus scabs. Small subcutaneous 
abscesses may sometimes appear, accompanied with sympa- 
thetic engorgement of the lymphatic glands of the neck. It 
has been remarked that the growth of those persons who 
have been affected with porrigo is often arrested, and the 
development of the mental as well as the physical powers, is 
slow and imperfect. The duration of the disease is very vari- 
able and uncertain ; and the hair when reproduced, is rarely 
the same as the original either in color or consistence. " — 
(Cazenave.) 

Porrigo scutulata commences with the appearance of red 
circular patches, upon which small yellow pustules are soon 
developed. Each pustule has a hair passing through it, and 
have the same cupped appearance as in the preceding variety ; 
and they appear more frequently upon the circumference of 
the spot than at its center. The scabs increase in thickness 
for some time, and when removed, a large furfuraceous patch 
with an uneven surface is left, from which the hair frequently 
falls off. It spreads by spontaneous development, or by inoc- 
ulation of other parts by scratching ; marked, and sometimes 
intense itching attending the eruption. Like the preceding 
affection, its duration is variable, but if allowed to run its 
course, it would probably continue for years, resulting in per- 
manent baldness. 

Diagnosis. — The presence of the small, rounded, yellow 
pustule, depressed in its center, is the diagnostic feature of 
both forms. Porrigo scutulata is determined by the appear- 
ance of the eruption in circular patches, though when these 
are numerous, they are so crowded together as to cover the 



Papula. 



563 



entire surface, and the distinction then between this and por- 
rigo favosa can not be made out. 

Treatment. — Cleanliness is of major importance in this affec- 
tion, and to secure it we would have the hair cut close, and 
the head frequently washed with Castile soap and water. It 
may be necessary at first to soften the incrustations by contin- 
uous emollient applications, or in some cases with poultices, 
using soap and water freely in the meantime. Having thus 
exposed the scalp, we would apply, #, Oxalic Acid, gr. x to 
gr. xx ; Creosote, gr. x; Aqua, 3ij; M., and follow it in half 
an hour with free inunction of mild Zinc ointment. The 
ointment of Iodide of Sulphur is a very efficient remedy, and 
when used should be gently rubbed over the parts night and 
morning, the scalp being kept perfectly clean by the use of 
soap and water. It is not necessary to name other topical 
applications, as these, if properly used, will be sufficient in all 
cases. 

As regards internal remedies, we will find it necessary to 
give the vegetable alteratives heretofore named, associated 
with some preparation of Potassa, as the Iodide, Acetate, 
Carbonate, etc. Usually, the bitter tonics and Iron will be 
required to some extent, and occasionally Cod-liver Oil will 
prove beneficial. 



ORDER Y.— PAPULAE. 

This order is characterized by small, firm, solid elevations 
of the skin, always attended with more or less itching, and 
never contain pus or serum, though occasionally from irritation 
these surfaces become ulcerated and covered with incrusta- 
tions. They are developed without any appreciable cause, 
are rarely attended with febrile symptoms, and are not con- 
tagious. They are most generally chronic, but sometimes 
acute. Two diseases are included under this order — lichen 
and prurigo. 

Lichen. 

Lichen appears as small, hard elevations, but slightly reel, 
or of the color of the skin, and attended with severe pruri- 
tus. We may distinguish three forms : L. simplex, L. agrius, 
L. urticatus. 

Lichen simplex comes out in the form of small and aggre- 



564 



The Eclectic Practice of Medicine. 



gated papulse, being attended with severe itching, and some- 
times burning. It most frequently appears on the face and 
arms, and the neck and breast, though it may extend to all 
parts of the body. They remain stationary for three or four 
days, when the redness gradually declines, there is slight fur- 
furaceous desquamation, and the disease terminates in seven 
or eight days, unless there is a new eruption. In many cases, 
it continues for weeks or months by the appearance of suc- 
cessive crops of papulae. 

Lichen urticatus usually appears suddenly in the form of 
large and numerous papulae, attended with a burning, dis- 
tressing pruritus. It appears most frequently on the face, 
neck, aud extremities, and is irregular and transitory, subsid- 
ing and reappearing with great rapidity. "The papulae are 
clustered, and they are either white or surrounded by a faint- 
red areola: sometimes they are prominent, and considerably 
inflamed, and at first bear considerable resemblance to flea 
bites." When scratched or otherwise irritated, they fre- 
quently bleed, and dark scabs form on their surface. The 
eruption may disappear with one crop of papulae, but it is 
occasionally very obstinate, lasting for months, by their suc- 
cessive reproduction. 

Lichen agrius may appear spontaneously, or it may succeed 
lichen simplex. When it appears spontaneously, the papulae 
are very small, red, accumulated, inflamed and developed on 
an erythematous surface of limited extent, which is generally 
attended with heat and painful tension. Instead of subsiding 
on the fourth or fifth day, they continue increasing: slight 
ulcerations form on their apices, whence issues a sero-purulent 
fluid, which concretes and forms yellowish, prominent crusts, 
soft and slightly adherent. These incrustations fall off, and 
•are then replaced by thin, scaly scabs. Sometimes the red- 
nsss diminishes, the inflammation disappears, slight desqua- 
mation ensues, and the disease terminates about the twelfth 
or fifteenth day. But frequently the discharge continues, and 
new crusts are formed, by which the disease is prolonged con- 
siderably. The itching which accompanies it is often so 
intense that the patient seeks the hardest substances to rub 
himself with, and thus invariably aggravates the pruritus. It 
may continue in this manner for several weeks, or it may pass 
into the chronic state, when the scaly incrustations disappear, 
and are succeeded by slight exfoliation, and the skin is often 



Lichen. 565 

considerably hypertrophied. This form may last for months. 
(Cazenave.) 

A peculiar form of disease has prevailed extensively in the 
Western country, for the last three years, known as Illinois 
itch, soldiers 9 itch, etc., presenting many of the characteristics 
above named. Its symptoms seem so variable, that it is diffi- 
cult to classify it, as it sometimes resembles eczema, and at 
others impetigo, and in others, again, it presents to some extent 
the characteristics of all three. It appears most generally 
upon the wrists and hands first, and then extends to various 
parts of the body, and is remarkably persistent and annoying. 

Diagnosis. — The diagnosis of lichen is very difficult, as it 
may be mistaken for eczema, porrigo, scabies, or impetigo, 
but it may usually be determined by the presence of some of 
the characteristic papula?. 

Treatment. — In lichen simplex we usually direct a mild 
purgative, followed by an alkaline diuretic, and the frequent 
use of the alkaline bath. In lichen urticatus I use internally 
a decoction of Asclepias and Scrophularia, with an alkaline 
diuretic, and the free use of the bath of Bi-carbonate of 
Potassa and water, followed by a decoction of Cornus, Alnus 
and Rumex. The Glycerin lotion, heretofore named, answers 
a good purpose, as does also a solution of Chlorate of Potassa, 
3j, to Water, Oj. 

Lichen agrius is more difficult to manage, and no remedy 
seems to answer in all cases. In some, I have had very good 
success with Glycerin and Tincture of Muriate of Iron, in 
the proportion of three parts of the first to one of the last, 
given internally in teaspoonful doses four times a day, and 
applied to the affected parts three times a day. A lotion of 
Muriate of Ammonia has been frequently employed, com- 
posed of, #, Hydrochlorate of Ammonia, 3 j ; Vinegar, 3iv; 
"Water, Oj ; and applied freely to the affected parts. In some 
cases the internal administration of the Compound Tincture 
of Corydalis, with Iodide of Potassium, and a wash of a 
decoction of equal parts of Cornus, Alnus and Rumex, has 
answered a good purpose. In other cases a lotion of, #, Gly- 
cerin, 3ij; Oxide of Zinc, 3ss; Morphia, gr. v; Rose water, 3iv; 
has answered an Jexcellent purpose, as has the ointment of 
Elder and the mild Zinc Ointment. In other cases, good 
results will be obtained by the internal use of Sulphur, and 
its local employment as a bath, wash, or ointment. 



566 The Eclectic Practice of Medicine. 



Prurigo. 

Several varieties of this disease are described, but many of 
them are named, not from any prominent difference of symp- 
toms, but more on account of their location. The disease is 
characterized by the appearance of papulae, usually larger 
than those of lichen, and without discoloration of the skin 
which are attended by very severe pruritus, and sometimes 
burning. Three varieties may be named, P. mitis, P. formi- 
cans, P. senilis. 

Prurigo mitis is the mildest form of the disease, and is usu- 
ally acute. The papulae are slightly prominent, but very 
small, and are accompanied with intense itching. In prurigo 
formicans the papulae are much larger, and flattened, and dis- 
tinct, and accompanied with an intolerable pruritus, which 
increases at night, and by the warmth of the bed. If not 
irritated by scratching, they frequently disappear in the 
course of one or two weeks, but frequently the skin is torn 
in the efforts for relief, and the part bleeds, and a dark thin 
scab is formed on its surface. It may continue for a consid- 
erable time by continued development of the eruption. In 
old people, or in weakly children, the papulae are frequently 
large and prominent, and the skin becomes thickened and 
inflamed; vesicles, pustules and boils form, and, being opened 
by scratching, give rise to unpleasant excoriations and super- 
ficial ulcers, and a most intense burning and itching. It may 
thus last for months, or even years. Prurigo may attack any 
part of the body, but is most severe when it attacks the geni- 
tal organs, or is situate around the anus. 

Diagnosis. — Prurigo may be distinguished from lichen by 
its larger papulae, and the dark incrustations which are some- 
times formed on them; from scabies by the accuminated vesicles 
of the latter, and their rose-colored base. It may be associated 
with lichen, scabies, eczema, impetigo and ecthyma, and in 
such cases the diagnosis will of course be difficult. 

Treatment. — In the milder forms of the disease, the removal 
of any internal irritation, and soothing local applications are 
all that is required. Frequently it is desirable to keep the 
bowels open with a saline purgative, and give an alkaline 
diuretic, with some gentle diaphoretic. As a local applica- 
tion, the Glycerin lotion will answer a very good purpose ; or 
we may use it with Chloroform, adding ten or fifteen drops 



Squama. 567 

of it, to each ounce of the lotion. A solution of Borax answers 
a good purpose, as #, Borax, 3\j ; Morphia, gr. v ; Rose-water, 
f3vj. A decoction of Hydrastis or Corn us with Borax and 
Morphia, are frequently beneficial. 

In the chronic forms of the disease, it is necessary to admin- 
ister the bitter tonics and Iron, accompanying them with a 
vegetable alterative, and alkaline diuretic. I have used for 
this purpose the pill of Quinia, Hydrastin, Podophyllin andNux 
Vomica, heretofore spoken of, with #, Essl. Tinctures of Col- 
linsonia, Corydalis and Cornus, aa, 3j ; Syrup of Prunus, 3iij ; 
M., and give in teaspoonful doses four times a day. This 
should be associated with Tincture of Muriate of Iron, in the 
usual doses, giving one for two or three days, and then the 
other. 



ORDER VI.— SQUAMAE. 

This form of skin disease is characterized by the formation 
of scales upon a thickened and reddened portion of the skin. 
In some cases they seem to result from change in the function 
of the epidermis, and at others to be formed by the desiccation 
of the secretions of the part. They are always chronic, and 
usually very persistent. The causes giving rise to them are 
unknown, and they are not confined to any class of society, 
age or sex. Four diseases are grouped under this order : lepra, 
psoriasis, pityriasis, and ichthyosis, the first and the last being 
of very rare occurrence. 

Lepra. 

Lepra most usually appears in the neighborhood of the 
joints, in the form of small red shining spots, a little elevated 
above the skin. In a short time they lose their smooth 
appearance, and become covered with thin scales which are 
constantly falling off, and being renewed. They increase in 
size, maintaining their circular form, until they are two or 
three inches in diameter, and the skin becoming thick and 
hard, movement of the joint is frequently impeded. The 
disease may extend to any part of the body, and in some cases 
will cover a considerable portion of the surface. In rare cases 
ulcerations occur, the result being the formation of unpleasant 
cicatrices. It may subside of itself, gradually disappearing in 
the course of two or three months, or it may disappear and 
return quickly again, but in many eases it persists for years. 



568 The Eclectic Practice of Medicine. 

Diagnosis. — It is usually diagnosed with ease, the appear- 
ance of the eruption in small circular patches, at first near the 
joints, and its gradual increase in size, being regular in its out- 
line, with the scaly secretion, is sufficiently distinctive. 

Treatment. — A more extended experience is necessary in 
order to test the value of our remedies, but in the few cases 
that have come under my notice, and have been reported to me, 
they have been successful. We employ a decoction of Celas- 
trus, Rumex, and Scrophularia freely as an internal remedy, 
associated with the Tlydrochiorate of Ammonia, and Chlorate 
of Potassa, alternated with the Tincture of Muriate of Iron. 
The same remedies may be used in the form of a tinc- 
ture or syrup, but it has seemed to me that a better influence 
was obtained from a decoction. Quinia and Hydrastin may 
be used at the same time, providing there seems to be a neces- 
sity for their administration. 

If the surface seems harsh, as is sometimes the case, we 
would use the general vapor bath, followed by the cold 
douche, and brisk friction, or the tepid or warm water sheet 
pack, followed by the douche, and friction as before. These 
means should be repeated daily in some cases, and once or 
twice a week in milder ones, and should be continued until 
the surface becomes soft and natural. To the affected part 
we may apply, #, Glycerin, 3ij; Benzoic Acid, 3ij; Oxide of 
Zinc, 3ss; Morphia, gr. v.; M., and apply freely; or, #, 
Tincture of Muriate of Iron, 3j; Glycerin, 3ij; or the May- 
er's Ointment, or that made from the bark of the Elder. In 
some cases benefit will be obtained from the use of a decoc- 
tion of equal parts of Cornus and Rumex, in addition to the 
means named. 

Pityriasis. 

Pityriasis is a chronic inflammation of the skin, attended 
with abundant furfuraceous desquamation. Its most frequent 
seat is the scalp, or parts covered with hair, and when the 
scales are removed, the part is seen to be slightly reddened in 
spots. 

Pityriasis capitis is most frequently seen in children, and is 
attended with but slight itching, and continued exfoliation 
of the epidermis. It is sometimes very persistent and intract- 
able. 

In pityriasis rubra, the disease appears in small red spots 



PSORIASIS. 



569 



which being aggregated form large patches which are usually 
hard, but sometimes of a normal softness. These patches 
soon become covered with minute scabs, which are contin- 
ually being thrown off and reproduced. 

Pityriasis versicolor appears in the same manner, but is 
distinguished by the variegated yellow discoloration of the 
cuticle. 

Diagnosis. — Pityriasis is usually recognized easily, as there 
is but little structural change of the skin, and continued and 
abundant furfuraceous desquamation. 

Treatment. — The treatment will be the same as psoriasis, 
which see. 

Psoriasis. 

Psoriasis is a species of chronic inflammation of the skin, in 
which in addition to some change of structure, there is a con- 
tinued formation and exfoliation of whitish scales. The 
causes of this disease are unknown, though sometimes it 
seems to be hereditary. Three varieties are named, P. Gut- 
tata, P. diffusa, and P. inveterata. 

Psoriasis guttata appears in the form of small red patches, 
irregularly rounded and elevated above the adjacent skin, and 
though they are almost always aggregated so as to form 
patches of considerable size, yet there is a distinct division 
between them, in which the skin retains its usual color. 
These patches are covered with thin scales, which are easily 
removed, and rapidly reproduced. It is met with on any 
part of the body, and is attended with slight itching, which is 
increased by the warmth of the bed. It occurs most fre- 
quently in young adults, and is rare either in childhood or 
old age. 

Psoriasis diffusa occurs in the form of flat, angular, irregu- 
lar and larger patches than the foregoing. They are at first 
red, of a papular form, and distinct; they speedily unite, and 
form continuous surfaces, covered with thick, whitish, and 
pretty adherent scaly incrustations. Although it may appear 
on every part of the body, the limbs are much more frequently 
affected than any other part. It is by no means uncommon 
to see one continuous patch covering the whole of the ante- 
rior surface of the leg, or the posterior aspect of the forearm. 
The elbows and knees are constantly affected, and even when 
it has disappeared from every other part of the body, it will 
remain fixed in these regions, from which it will be difficult to 



570 



The Eclectic Practice of Medicine. 



remove it. It is generally preceded by slight constitutional 
disturbance, together with a troublesome, severe itching, 
which, however, soon subsides, and disappears when the 
eruption is developed. 

In some cases the patches are not inflamed, and the patient 
merely complains of slight formication; but in a few rare 
instances there is considerable inflammation present; the 
patches are prominent, and the scales thick, and painful fis- 
sures and chaps are established, which annoy the patient con- 
siderably. It generally attacks adults ; nevertheless it some- 
times occurs in young children, and its progress in these cases 
is often remarkably rapid. It is always a severe and intracta- 
ble disease, lasting for months and even years, 

"Psoriasis inveterata is the same affection as the foregoing, 
but of a more severe form. It occurs most frequently in aged 
persons, and in broken-down constitutions, and often attains a 
high degree of intensity. The skin becomes thick, hard and 
hypertrophied; it is split in different directions, and the scales 
are no longer of the usual size and thickness, but a sort of 
furfuraceous desquamation takes place, which fills up the fur- 
rows or fissures, and is readily detected. Sometimes, in these 
cases, the morbid surfaces are entirely deprived of scales, and 
are red, slightly inflamed, and furrowed in every direction. 
On pinching up the skin between the fingers, it is found to be 
deeply altered, and feels rough, hard and uneven. The erup- 
tion is sometimes confined to the limbs; in other instances, it 
spreads over the whole body; and in some rare cases, the 
patient seems as if encased in a scaly envelope. The slightest 
movement of the joints produces deep, bleeding and painful 
fissures. The nails are also affected, and are misshapen, 
rough and ragged ; they split into pieces and are replaced by 
scaly incrustations." — (Cazenave.) 

Psoriasis sometimes appears about the angles of the eyes, 
and on the lids, giving rise to considerable irritation and 
swelling. Occasionally it extends to the conjunctivae, occa- 
sioning a most obstinate conjunctivitis; in these cases it is 
denominated psoriasis ojphthalmica. At other times it attacks 
the lips, which become dry and corrugated, fissures of greater 
or less depth, passing from the margin of the lip outward. It 
lisually extends for half or three-quarters of an inch around 
the mouth, and in addition to the dryness, hardness and con- 
tinued desquamation, there is a dusky-red discoloration, which 



Psoriasis. 



571 



gives the countenance a very unpleasant appearance; this has 
been named psoriasis labialis ; it may attack the prepuce in a 
similar manner, rendering it hard and rough, and so corru- 
gated that it can not be drawn back from the glans, without 
very severe pain and bleeding, and in some cases produces 
permanent phymosis — psoriasis prseputialis. These varieties 
are usually very stubborn and difficult to manage, and give 
the practitioner a great deal of trouble. 

Psoriasis palmaris, grocer's or baker's itch, commences with 
the appearance of firm red points in the palm of the hand? 
accompanied with a sensation of itching and burning. These 
spots are soon covered with whitish scales, which when 
removed, leave a purplish- red spot. 

It generally extends from the circumference until it involves 
the entire hand, leaving it purple, hard and chapped; so 
much so at times, that the blood gushes from the hands when 
using them, or they are so stiff, that they can not be used at 
all. When it attacks the back of the hands it is termed psor- 
iasis dorsalis, and does not differ from the foregoing further 
than that the patches are larger, harder and drier ; extending 
to the articulations, it gives rise to deep and painful fissures. 

Diagnosis. — From the description above given, the reader 
will have but little difficulty in its diagnosis. The patches 
are always elevated in the center, whilst in lepra the center is 
depressed, and in lichen, we will always be enabled to deter- 
mine the papulae. 

Prognosis. — Psoriasis is a difficult disease to cure, and 
requires much time and perseverance, yet a large majority of 
cases will yield to treatment. Psoriasis inveterata is the most 
difficult, and in many cases, it will not yield to remedies. 

Treatment. — The treatment of this affection is essentially 
the same as for lepra, depending more upon internal remedies 
than upon local applications. If not very severe, I have had 
no trouble in its removal with the internal use of the Com- 
pound Tincture of Corydalis and Bromide of Potassa, given 
in full doses, and the local application of a decoction of equal 
parts of Cornus, Alnus and Runiex, or the tinctures of the 
same diluted, followed by a lotion of Glycerin, as heretofore 
named. In the severer cases, I use the remedies in decoc- 
tion, giving them freely, say combinations of Rumex, Alnus, 
Scrophularia, Stillingia, Corydalis, etc., alternating them so as 
to keep up their effect. An occasional emetic is frequently 



572 The Eclectic Practice of Medicine. 

useful, as is also a solution of Acetate or Citrate of Potassa, 
and the bitter tonics must be used to such extent as to keep 
the digestive organs in good condition. One of the most 
important means in long-standing cases is the use of the 
warm wet sheet pack, followed by the cold douche and brisk 
friction. The Sulphur and Iodine vapor, directed on the dis- 
eased part, will occasionally be found useful, though the local 
means recommended under the head of lepra will usually be 
sufficient. 

Ichthyosis. 

Ichthyosis, or the fish-skin disease, is not an accidental 
alteration of the skin, but an organic change in its develop- 
ment. The causes of it are unknown, but it is frequently 
congenital, or at least there is the commencing change in the 
skin at birth, which results in ichthyosis. It is a very rare 
form of disease, and is seldom or never met with in a lifetime s 
practice. It is characterized by a peculiar dry and harsh 
appearance of the skin, and the development of hard, dry, 
imbricated scales, of a dirty red color, unaccompanied by 
heat, inflammation or any unpleasant sensation. It appears 
principally on the external aspects of the limbs — round the 
joints, on the knee and elbow, on the upper part of the back, 
and on those regions where the skin is naturally thick and 
coarse. It is most usually general, but is sometimes limited to 
a particular part, especially where it is accidental, sometimes 
affecting the arms and legs only. It is generally a congenital 
disease, and lasts through life. When fully developed, its 
appearance is so peculiar that it can not be mistaken for any 
other affection. When congenital, it is incurable, but when 
accidentally developed, it may be arrested, though it is said 
to be very intractable. The treatment recommended for 
lepra and psoriasis may be used in these cases. 



INDEX 



Acne, 558 

simplex, 559 

indurata, 559 

rosacea, 559 

Acute bronchitis, 116 

enteritis, 255 

cystitis, 351 

gastritis, 223 

hepatitis, 241 

hydrocephalus, 403 

laryngitis, 103 

nephritis, 326 

synovitis, 387 

Albuminuria, 332 

chronic, 333 

Amaurosis, 519 

Anasarca, 207 

Aneurism, 189 

thoracic, 190 

of the abdominal aorta, 191 

nervous, 189 

Angina pectoris, 173 

Aphonia, 114 

Apthse, 217 

Apoplexy, 422 

Articulations, diseases of the, 386 

Arteritis, 187 

Ascites, 207 

Asiatic cholera, 273 

Asthenic bronchitis, 119 

Asthma, 138 

treatment of, 140 

Attenuation of the walls of the 

heart, 185 

Auscultation, 85 

adventitious sounds in, 88 

Barber's itch, 560 

Bilious colic, 290 

Bilious fever, 22 

treatment of, 25 

Bleeding from the lungs, 151 

of, 351 



Bones, inflammation of, 381 

strumous diseases of, 384 

Brain, inflammation of, 398 

dropsy of the, 407 

Bronchitis, catarrhal, 116 

sthenic, 117 

asthenic, 119 

chronic, 123 

treatment of acute, 120 

treatment of chronic, 126 

Bulla?, 552 

Csecum, disease of, 295 

Calculi, renal, 350 

Cancer of the stomach, 232 

Carditis, 179 

Cataract, 523 

Catarrh, epidemic, 91 

Catarrhal bronchitis, 116 

gastritis, 225 

Causes of fever, 5 

Cephalalgia, 488 

Cerebritis, 399 

Chicken pox, 67 

Chronic pharyngitis, 93 

bronchitis, 123 

pneumonia, 135 

pleuritis, 157 

structural diseases of the heart, 183 

gastritis, 226 

enteritis, 260 

dysentery, 305 

nephritis, 328 

cystitis, 353 

rheumatism, 375 

osteitis, 382 

diseases of the joints, 391 

hydrocephalus, 407 

Cholera, Asiatic, 273 

infantum, 279 

morbus, 271 

Chorea, 452 

Circulatory apparatus, diseases of, 163 



574 



Index. 



PAGE 

Common continued fever, 33 

with predominant affection of 

the cerebro-spinal system,... 37 
of the respiratory apparatus,... 38 
of the gastro-enteric mucous 

memhrane, 38 

treatment of, 39 

Congestive intermittent fever, 18 

chill, 18 

treatment of, 20 

remittent fever, 27 

treatment of, 28 

Conjunctivitis catarrhal, 500 

purulent, 503 

chronic, 506 

Consumption, 143 

Convulsions, : 436 

Colic, 289 

bilious, 290 

lead, 292 

Colica pictonum, 292 

Collitis, 297 

Cornea, opacity of, 518 

Cough, 80 

whooping, 159 

Coup de soliel, 427 

Cow pox, 65 

Croup, 109 

mucous, 110 

pseudo-membranous, 110 

spasmodic, Ill 

Coryza, 90 

Curvature of the spine, 417 

Cynanche maligna, 99 

Cystitis, acute, 351 

chronic, 353 

Deafness, 531 

Deficient action of the liver, 247 

Delirium tremens, 448 

Dentition, derangements of, 211 

Diabetes, 339 

insipidus, 339 

mellitus,, 340 

Diagnosis, physical, 78 

Diarrhoea, 267 

bilious, 268 

feculent, 269 

from atony, 270 

from determination, 270 

lienteric, 271 

chronic, 260 



PAGE 

Digestive apparatus, diseases of,.... 211 

Diphtheria. 94 

Diseases of the respiratory appa- 
ratus, 78 

circulatory apparatus, 163 

heart, 163 

digestive apparatus, 211 

caecum, 295 

urinary apparatus, 325 

organs of locomotion, 367 

joints, 386 

nervous system, 397 

organs of special sense, 496 

skin, 535 

Dropsy, 204 

sthenic, 205 

asthenic, 205 

from disease of the heart, 206 

liver and spleen, 206 

of the cellular tissue, 207 

abdomen, 207 

thorax, 207 

pericardium, 207 

treatment of, 208 

of the articulations, 392 

brain, 407 

Dysentery, 297 

epidemic, 298 

chronic, 305 

Dyspepsia, 234 

Dysphagia, 221 

Ear, inflammation of the, 526 

Eczema, 546 

impetignodes, 546 

rubrum, 546 

chronic, 547 

Ecthyma, 555 

chronic, 555 

Egyptian ophthalmia, 503 

Embolismus, 197 

Emphysema, 142 

Eruptive fevers, 57 

Endocarditis, 180 

Enfeebled action of the heart, 165 

Enteritis, acute, 255 

mucus, 257 

chronic, 260 

Enuresis, 348 

Epidemic catarrh, 91 

cholera, 273 

dysentery, 298 



Index. 



575 



PAGE 

Epilepsy,..,, 430 

Erythema 537 

Erysipelas, 538 

phlegmonous, 539 

gangrenous, 540 

Exanthemata, 537 

Excessive action of the liver, 246 

Excited action of the heart, 169 

Eye, diseases of the, 496 

Eyelids, inflammation of, 497 

Febrile diseases, 5 

Fever, causes of, 5 

phenomena of, 8 

stage of incubation, 8 

cold stage, 9 

hot stage, 9 

stage of excretion, 9 

divisions of idiopathic, 10 

intermittent, ....... ,..., 10 

inflammatory intermittent, 15 

gastric intermittent, 16 

masked intermittent, ,.. 18 

congestive intermittent, 18 

remittent, 22 

bilious, 22 

congestive remittent, 27 

yellow, 28 

synochus, . 32 

inflammatory, 32 

synochoid, 35 

common continued, 35 

typhoid, 42 

complications of, 46 

typhus, 52 

eruptive, 57 

Fissure of the rectum, 315 

Fistula lachrymalis, 525 

Fits, 436 

Functional diseases of the liver,... 246 

Gallstones, 250 

Gangrenous stomatitis, 219 

Gastric intermittent fever, 16 

treatment of, 17 

Gastritis, acute, 223 

catarrhal, 225 

chronic, 226 

Glaucoma, 521 

Granular conjunctiva, 507 

Granular disease of the kidney,... 332 



PAGE 

Hemorrhoids, 316 

Headache,., 438 

from determination, 489 

ana&mia, 49Q 

eold, 49 

pericranial, 491 

from deficient action of the kid- 

°«r*j 482 

from derangement of the stom- 

ach ; 492 

rheumatic, 493 

periodic, 494 

sympathetic, 494 

Heart, diseases of the, 163 

structure and relations of the, 164 

enfeebled action of the,.. 165 

irregular action of the, 167 

excited action of the, 169 

neuralgia of the, 171 

inflammation of the, 175 

rheumatism of the, 176 

chronic structural disease of 

^e, 183 

hypertrophy of the, 184 

attenuation of the walls of the, 185 
alterations of the structure of 

the 185 

disease of the valves of the,... 185 

Hectic fever, 150 

Hematuria, 337 

Hemiplegia, 477 

Hemoptysis, 151 

treatment of. 152 

Hemorrhage from the lungs, 151 

Hemorrhage from the kidneys, 337 

Hepatitis, 241 

chronic, 243 

Herpes, 548 

phlyctenodes, 548 

labialis, 548 

prseputialis, 549 

zoster, 549 

circinatus, 549 

Humid tetter, 546 

Hydropericardium, 207 

Hydrarthrosis, 392 

Hydrocephalus, acute, 403 

chronic, 407 

Hydrophobia, 443 

Hypertrophy of the heart, 184 

spleen, 266 



576 



Index. 



Hypochondriasis, 460 

Ichthyosis, 572 

Ileus, 286 

Impetigo, 556 

figurata, 556 

larvalis, 557 

capitis, 557 

Incontinence of urine, 348 

Impactus, 286 

Inflammation of the lungs, 129 

pleura, 153 

heart, 175 

arteries, 187 

veins, 192 

bowels, 255 

spleen, 262 

caacum, 295 

colon, 297 

kidneys, 326 

bladder, 351 

periosteum, 378 

bones, 381 

joints, 387 

brain, 398 

spinal cord, 410 

ear, 526 

conjunctiva, 500 

Inflammatory fever, 32 

rheumatism, 368 

Influenza, 91 

Intermittent fever, 11 

general description, 11 

simple, 11 

diagnosis, 13 

treatment, 13 



inflammatory, 



gastric, 16 

masked, 18 

congestive, 18 

Intestinal worms, ^ 309 

Irregular action of the heart, 167 

Iritis, 512 

syphilitic, 513 

scrofulous, 513 

Irritation, spinal, 413 

Ischuria, 344 

Itch, 550 

Jaundice, 252 

Joints, diseases of the, 386 



Kidneys, acute inflammation of the, 326 Obstruction of the bowels, 286 



Kidneys, chronic inflammation of 

the, 328 

Bright's disease of the, 332 

hemorrhage from the, '.:....'.. 337 

Lachrymal apparatus, diseases of 

the, 524 

sac, inflammation of the 524 

Laryngitis, acute, 103 

catarrhal, 103 

asthenic, \ 104 

chronic, 106 

Lead colic, 292 

Lepra, 567 

Lichen, 568 

Liver, functional diseases of the,... 246 

excessive action of the, 246 

deficient action of the, 247 

neuralgia of the, 249 

Lock-jaw, 439 

Loss of voice, 114 

Malignant remittent fever, 27 

sore throat. 99 

Mania-a-potu, 448 

Materies morbi in fever, 6 

Measles, 68 

Meningitis, spinal, 410 

Mentagra, 560 

Mercurial stomatitis, 218 

Milaria, 545 

Mucous croup, 110 

Muco-enteritis, 257 

Nephritis, acute, 326 

chronic, 328 

Nervous pulsation, simulating aneu- 
rism, 189 

Nervous system, diseases of the,... 397 

Neuralgia of the heart, 171 

liver, 249 

rectum, 320 

Neuralgia, 465 

facial, 466 

of the back, 467 

sciatic, 468 

of the upper extremities, 469 

visceral, 469 

Night sweats, 150 

Nursing; sore 



Index. 



577 



PAGE 

Odontalgia, 213 

(Edema glottidis,.. 104 

Opacity of the cornea, 518 

Ophthalmia, phlegmonous, 516 

tarsi, 498 

Egyptian, 503 

rheumatic, 510 

Osteitis, 381 

chronic, 382 

Otitis, 526 

Otorrhoea, 529 

Ozcena, 92 

Palsy, 473 

wasting, 482 

shaking, 483 

Pancreas, diseases of the, 266 

Papulae, 564 

Paralysis, 473 

from disease of the brain, 476 

spinal cord, 479 

nerves, 481 

Paraplegia, 480 

Passage of renal calculi, 350 

Pemphigus, 552 

Perforating ulcer of the stomach,... 230 

Pericarditis, 178 

Peripneumonia-notha, 119 

Peritonitis, 321 

Periostitis, 378 

Pertussis, , 159 

Pharyngitis, chronic, 92 

Phenomena of fever, 8 

Phlebitis, 192 

Phlegmonous ophthalmia, 516 

Phrenitis, 398 

Phthisis pulmonalis, 143 

treatment of, 148 

Physical diagnosis, 78 

conformation of the thorax,... 78 

respiration, 79 

cough, 80 

sputa, s 81 

percussion, 83 

auscultation, 85 

Piles 316 

Pityriasis, 568 

Pleuro-pneumonia, 131 

Pleuritis, 153 

Pleurisy, 153 

treatment of, 156 

pleuritis, chronic, 157 

37 



PAGE 

Pleuritis, treatment of, 158 

Pneumonia, 129 

typhoid, 131 

treatment, of, 133 

chronic, 135 

Porrigo, 561 

Preservation of vaccine matter, 66 

Prurigo, , 566 

Pseudo-membranous croup, 110 

Psoriasis, 569 

Pterygium, 526 

Pustute, 555 

Pyemia, 194 

Quinsy, 100 

Rabies, 443 

Rectum, stricture of the, 314 

fissure of the, 315 

neuralgia of the, 320 

Remittent fever, 22 

complications of, 24 

treatment of, 25 

congestive, 27 

Renal calculi, passage of, 350 

Respiration, 79 

Respiratory apparatus, diseases of 

the, 78 

Retention of urine, 345 

Rheumatism, 367 

inflammatory, 368 

subacute, 370 

chronic, 375 

of the heart, 176 

Rheumatic fever, 368 

ophthalmia, 510 

Ring-worm, '. 549 

Roseola, 542 

Rose-rash, 542 

Rubeola, / 68 

Running-scall. 546 

Rupia, 553 

simplex, 553 

prominens, 553 

escharotica, 554 

Scabies, 550 

Scald-head, 561 

Scarlatina, 71 

anginosa, 71 

maligna, 72 

Scarlet fever, IX 



578 



Index. 



Scarlet fever, sequelae of, 74 

treatment of, 74 

Sciatica, ~ 468 

Scrofula, 198 

treatment of, 202 

Shingles, 549 

Skin, diseases of the, 535 

Small pox, 59 

treatment of, 63 

Sore throat, malignant, 99 

Sore mouth, 214 

nurses, 220 

malignant, 219 

Spasmodic croup, '. Ill 

Spermatorrhoea, 456 

Spinal meningitis, 410 

irritation, 413 

Spine, curvature of the, 417 

Splenitis, 262 

Spleen, hypertrophy of the, 266 

Squamae, 567 

Sputa, 81 

St. Vitus' dance, 452 

Sthenic bronchitis, 117 

Stomach, ulceration of the, 228 

perforating ulcer of the, 230 

cancer of the, 232 

Stomatitis, 214 

chronic, 215 

pseudo-membranous, 216 

ulcerative, 217 

mercurial, 218 

gangrenous, 219 

Stricture of the pylorus, 231 

rectum, 314 

Strumous disease of the bones, 384 

synovitis, 392 

articular osteitis, 392 

Sub-acute rheumatism, 370 

Sudamina, 545 

Summer complaint, 279 

Sun stroke, 427 

Suppression of urine, 344 

Sycosis, 560 

Synochus fever, 32 

complications of, 33 

treatment of, 34 

Synochoid fever, 35 



PAQS 

Synochoid fever, treatment of, 39 

Synovitis, acute, 387 

Tabes mesenterica, 284 

Taenia, 311 

Teething, 211 

Tetanus, 439 

Tinea capitis, 561 

Toothache, 213 

Tonsilitis, 100 

Trichiasis, 498 

Tubercles of the lun^s, 143 

Tuberculous disease of the bowels, 284 

Typhoid fever, 42 

complications of, 46 

treatment of, 47 

Typhus fever, 52 

treatment of, 55 

Typhoid pneumonia, 131 

Ulcerative stomatitis, 217 

Ulceration of the stomach, 298 

Urinary apparatus, diseases of the, 325 

Urine, suppression of the, 344 

retention of the, 345 

incontinence of the, 348 

Urinary deposits, 357 

Urticaria, 544 

Vaccination, 66 

Vaccine matter, preservation of,... 66 
Valves of the heart, diseases of 

the, 185 

Variola, 59 

treatment of, 63 

vaccinia, 64 

Varioloid, 64 

Varicella, 67 

Vesiculae, 545 

White swelling, 391 

Whooping cough, 159 

treatment of, 161 

Worms, intestinal, 309 

Yellow fever, 28 

treatment of, 31 



38 



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